AS1-328 MID-TERM STEM SURVIVAL AND PATIENT ACTIVITY AFTER HEMIARTHROPLASTY
COMPARING AN EXETER, ACCOLADE TMZF AND ACCOLADE HFX STEM
Spaans E1, Wagenmakers R1, Koenraadt K2,
Elmans L1, van den Hout J1, Bolder S1
1Amphia Hospital, Breda, The Netherlands; 2Amphia Hospital,
Foundation for Orthopaedic Research, Care and Education, Breda, The Netherlands
Introduction/objectives: Cemented stems with an ODEP rating of >3B
are recommended for hemiarthroplasty when treating an intracapsular fracture of the
femoral neck. We retrospectively analysed outcome of hemiarthroplasties with three
different stems. We also measured the level of activity and restrictions in ADL in
patients who were still alive at time of follow-up.
Methods: Between March 2009 and January 2014 we included 739 patients
with 759 hemiarthroplasties. We used an Accolade TMZF stem (ODEP 7A) in 186 hips,
Accolade HFx stem (no HA coating) in 493 hips and cemented Exeter stem (ODEP 10A*)
in 80 hips. Stem survival was compared with log rank tests. Patients alive (n = 268)
at time of analysis were sent validated questionnaires: EQ-5D, HOOS-PS, GARS
(Groningen Activity Restriction Scale) and midthigh pain. Data were compared using
one-way-ANOVA tests.
Results: Mean age at time of surgery was 84 (45-101). Mean follow-up was
2.2 years (1.0-6.7). Most patients (n = 471) had died during follow-up with no
difference in deaths between the groups using chi-square test (p = 0.26). Cumulative
survival at 5 years was 94.1% for the Accolade TMZF, 92.2% for the Accolade Hfx and
98.7% for the Exeter stem respectively, with no significant difference (p = 0.29).
Questionnaires had low response rate (30%), but yielded no significant differences
between the groups. Mean EQ-5D was 57 ± 20 (lower than a general norm population
70-79) and mean GARS was 43 ± 15.7 (comparable to a general norm population of
85+).
Conclusions: We support the suggestion that a proven uncemented hip
design can be used for hemiarthroplasty. We did not find a significant difference in
stem survival or patient activity after hemiarthroplasty using a cemented or
uncemented stem.
AS1-150 THE DIRECT ANTERIOR APPROACH TOTAL HIP ARTHROPLASTY LEARNING CURVE:
EVALUATION OF THE FIRST 70 CASES
Kurincic N, Cerneka K
Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
Introduction/objectives: The direct anterior approach (DAA) for total
hip arthroplasty (THA) has the advantages of using intermuscular and internervous
planes which allows faster recovery, less pain after surgery and low dislocation
rates. However there is some concern about long learning curve and the high number
of complications induced by the technique. The aim of this study was to
prospectively analyse the learning curve for the DAA performed by a single surgeon
experienced in direct lateral approach.
Methods: 70 consecutive patients underwent DAA THA on standard operative
table. There were 67 primary arthroses, 2 avascular necrosis and 1 femoral neck
fracture.
Operating time, blood loss, number of transfusions, peri-operative complications and
hospitalisation time were assessed. Patients were evaluated with the Harris Hip
Score (HHS) before, 1 and 3 months after surgery. Radiographs were done immediately
after surgery and at the follow-ups, in order to assess positioning of the
components. The average follow up period was 5 months.
Results: Average operating time was 76 min (range 45-115 min), blood
loss 371 ml (range 100-900 ml), number of transfusions 0.5 (range 0-4) and
postoperative hospitalisation 5.3 days (range 3-26 days). We had 4 major surgical
complications: early deep infection, intraoperative calcar fracture, dislocation,
partial n. femoralis palsy and femoral component subsidence. HHS improved from 56
pre-operatively to 85 at 3-month follow-up. Average cup inclination was 43° and
anteversion 15°.
Conclusions: Graphical analysis of the results showed that we have
reached the learning curve plateau. Comparison with the data available in the
literature is satisfying, so we will continue to use DAA as our main approach for
THA.
AS1-188 OUR MID-TERM RESULTS WITH DUAL MOBILITY ACETABULAR CUP AFTER 1218
CASES
Kavcic G, Bedencic K, Gosnik B
General Hospital Novo Mesto, Novo Mesto, Slovenia
Introduction/objectives: Dual mobility acetabular cup is composed of
metal acetabular cup, which is highly polished on the inner side. Its main advantage
is movement between both acetabular components. Polyethylene insert fits into highly
polished cup and moves freely within it. Movement is allowed on two levels. Majority
of movement is between polyethylene insert and metal or ceramic head, but in the end
point movements polyethylene insert also moves inside the acetabular cup.
Methods: From March 2004 to March 2016 we implanted 1218 dual mobility
acetabular cups (Avantage - Biomet) in 1110 patients. Follow up was from 1 month to
125 months. Average age of patients was 76 years (from 29 to 98). 762 were females
and 348 males. In 250 cases operation was due to fracture of the femoral neck or
pertrochanteric fracture. In all patients, excluding those with acute fracture,
Harris Hip Score was measured pre-operatively and post-operatively.
Results: Average Harris Hip Score pre-operatively was 44, 23 and 87, 95
postoperatively. We diagnosed infection of prosthesis in 13 cases and in 3 cases
infection of subcutis above the fascia, femoral nerve palsy in 1 case, periprothetic
fracture in 11 cases and 1 case of acute AFS thrombosis. So far we had no luxation
of prosthesis.
Conclusions: In our series we observed good functional results after
implantation of dual mobility acetabular cup. Main advantage of this cup is
definitely extremely low risk for luxation, that is why rapid rehabilitation without
classical postoperative limitations is possible. Our midterm results regarding
aseptic loosening are good, but we are still waiting for our long-term results. In
our institution this is the treatment of choice for patients with hip osteoarthritis
who are more than 70 years old.
AS1-235 PRIMARY TOTAL HIP ARTHROPLASTY IN JAPANESE OCTOGENARIANS WHO HAVE
LONGEST LIFE SPAN IN THE WORLD
Abe I, Shirai C
Chiba Medical Center, National Hospital Organization, Joint Surgery Center, Chiba
City, Chiba Prefecture, Japan
Introduction/objectives: The purpose of this study is to report the
results of a series of patients who were 80 years or older at the time of total hip
arthroplasty (THA) in Japan which has the longest life span in the world.
Methods: Forty-one THAs of 39 patients, aged 80 or older were
investigated retrospectively. The average term of follow-up was 57.5 months.
Pre-Operative complication were hypertension on 32 patients, heart disease on 8
patients, diabetes on 7 patients and dementia on 2 patients. Clinical assessment
included Harris hip score (HHS), length of hospitalization, perioperative medical
complication and gait ability. And their results were compared to the result of the
control patients 60 aged or younger. Radiographic assessment included implant
stability.
Results: Total HHS was improved statistically in both groups aged 80 or
older and aged 60 or younger. There were statistical difference in gait score of HHS
between them (≥80 ys group: ave. 12.3 points, ≤60 ys group: ave. 16.7 points). And
there was statistical difference on the hospitalization length between them (≥80 ys
group: ave. 39.1 days, ≤60 ys group: ave. 25.2 days). As to postoperative
complication in the ≥80 ys patients, the most common complication was transient
confusion in 4 patients and mortal complication was not observed. At the time of
completion of follow-up, three patients had died. The average time to death was 99.3
months after THA and the death was not directly related to THA. The gait ability was
improved in 27 patients. All implants were radiographically stable.
Conclusions: THA surgery is an effective and safe treatment for elderly
hip patients, but detailed pre-operative check of general condition and enough
length of hospitalization are necessary for good result.
AS1-396 COMPARING THREE DIFFERENT POST-OPERATIVE CHEMICAL VENOUS
THROMBO-EMBOLISM PROPHYLAXIS (VTE) IN ARTHROPLASTY PATIENTS
Shah N1, Siddiq F2, Baskaran
D1, Qamar F1, Shetty A1, Ng
A1
Introduction/objectives: Venous Thrombo-embolism (VTE) prophylaxis in
arthroplasty patients has been a subject of controversy, despite NICE guidance.
There is insufficient evidence to guide best practice and it is important to answer
this question as each type of prophylaxis has some adverse outcomes. This study aims
to compare Clexane, Rivaroxaban and Apixaban as VTE chemical prophylaxis for
patients following total joint replacement.
Methods: A retrospective review of three groups of 100 patients each
given Clexane, Rivaroxaban and Apixaban respectively. Case notes were reviewed for
data collection.
Results: It was found 24% of patients given Rivaroxaban had wound
leakage for 5 days or more, while in the case of Clexane and Apixaban these
percentages were 10% and 8% respectively. The average length of stay for patients
given Clexane and Apixaban was 4 days each and 5.5 days for Rivaroxaban. None of the
patients given Clexane required readmissions while the incidence for Rivaroxaban and
Apixaban were 5% and 3% respectively. 2% of patients of Rivaroxaban underwent redo
surgery, 3% with Apixaban and none for Clexane. There was a 3% incidence of VTE with
Clexane, 4% with Rivaroxaban and none with Apixaban.
Conclusions: Rivaroxaban has a significantly higher number of patients
who had wound leakage and it also had the highest average length of stay. Apixaban
had the lowest incidence of wound leakage. The risk of redo surgery was lowest for
Clexane. Importantly, there was no VTE noted in the Apixaban cohort. On balance, we
would recommend the use of Apixaban post-operatively for arthroplasty patients,
based on the overall favourable outcomes outlined above. It is well tolerated as it
is oral and suited for use in the community as no dose adjustment or monitoring is
required.
AS1-434 COSTS ANALYSIS OF FEMORAL HEADS DONATION PROCEDURE IN TOTAL HIP
ARTHROPLASTY AND BONE GRAFTING FOR HIP REVISION SURGERY
Rizzi L, Castelli C
Department of Orthopaedics and Trauma, Papa Giovanni XXIII Hospital, Bergamo,
Italy
Introduction/objectives: More than 100,000 hip replacements are
performed in Italy annually in which the femoral heads (FH) are removed, and over
10,000 hip revision procedures in which bone grafts are needed for filling the bone
defects. Aim of this study is to perform costs analysis of the FH removal procedure,
during primary hip arthroplasty, for donation to the Regional Bone Bank (RBB) by
comparing it with the costs for bone grafts provided by the RBB for revision
surgery.
Methods: From April 2013 to June 2014 385 patients were assessed as
potential donors of FH, but only 141 FH were sent to the RBB. 22 FH were refused so
the heads at last donated were 119. 48 FH were requested to the RBB to perform bone
grafts in hip revision surgery. Costs analyses were performed by calculating costs
and proceeds of bone donation procedure, and costs of bone grafts in revision
surgery. Cost per unit of donated FH and those provided by the RBB including costs
for the preparation of the graft to be transplanted were also calculated.
Results: Total cost of donation procedure was €80,099, total refund
obtained was €30,940 with a loss of €49,159 and a single FB liabilities of €413.
Spending on bone grafts was €35,760 with a unit cost of €1,679 and an average cost
per gram of bone of €19.76. Final cost of bone graft provided by the RBB is more
than twice the price of the graft and it is due to material and personnel costs to
prepare the graft to be transplanted.
Conclusions: Donation procedure of FH generates an economic loss due to
the exams to select the candidate and to screen FH. Reimbursement accounts for only
a third of the cost. Costs analyses allow comparing the cost of bone graft with
different available synthetic bone substitutes.
AS1-88 CONVERSION OF HEMIARTHROPLASTY TO TOTAL HIP ARTHROPLASTY
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Hemiarthroplasty (unipolar and bipolar) are
prevalently used for management of proximal femoral fractures. Several causes can
lead to required conversion total hip arthroplasty. It has been reported that
conversion of hemiarthroplasty to total joint replacement can be associated with
high rates of complications. We investigated the outcomes of conversion THA in
patients underwent hemiarthroplasty proximal femoral fracture.
Methods: There were 50 patients who had undergone hemiarthroplasty
following a proximal femoral fracture. The patients aged 61.2 ± 11.4 years at the
time of hemiarthroplasty. There were 21 females and 29 males. The groin pain was the
main complaint of the patients. The second important complaint of most of the
patients was limping due to shortening of the affected limb (34 patients). The
interval between hemiarthroplasty and conversion THA was 1.9 years. The patients
were followed for 3.2 years.
Results: 4 patients lost during follow up. Harris hip score improved
significantly from 52.6 ± 13.5 to 82.3 ± 10.7. Forty two patients were able to
ambulate independently (91.3%). Nine patients reported mild to moderate groin pain
while others were completely pain free. Dislocation occurred in two patient
necessitating revision surgery.
Conclusions: Short-term outcomes of conversion THA were promising. The
procedure is safe and results in considerable functional improvement and pain
relief. However, long-term investigations are highly required.
AS1-247 TRABECULAR METAL FOR ACETABULAR DEFECTS IN HIP REVISION SURGERY. SHORT
TERM CLINICAL AND RADIOGRAPHIC EVALUATION
Introduction/objectives: Trabecular Metal (TM) acetabular implants
provide a potential solution for dealing with significant acetabular bone loss in
hip revision surgery.
The aim of this study was to assess the early clinical and radiological outcome of
acetabular revision using TM cups and augments for acetabular reconstruction.
Methods: The study included 32 consecutive patients with failed
acetabular components after total hip arthroplasty. All patients underwent revision
surgery using a TM acetabular shell, whereas in 10 cases augments were associated
and 3 cases required cages.
All patients had conventional radiographs of the pelvis and the hip in both
pre-operative and follow-up evaluations and were clinically evaluated according to
WOMAC and HHS scores at 1 month, at 6 months and then at 1 year. Radiological
evaluation investigated, with OsiriX v. 7.0, the restore of hip centre of rotation
(COR) and signs of radiolucent lines and loosening.
All statistical analyses were performed using SPSS Version 14.0. Statistical
significance was set at p values of <0.05.
Results: Mean age at the time of surgery was 69.5 years. Median follow
up was 18 months (12-24 months).
At last follow-up, 21 patients showed excellent results according to the WOMAC and
HHS score and significant improvement (p<0.01), whereas 11 patients showed
limitation in gait and function. COR was restored in 87% of cases (p<0.01). The
acetabular components and augments appeared osteointegrated, and no sign of
loosening were found.
Conclusions: Based on these early clinical and radiological results, TM
acetabular components and augments for acetabular defects (Paprosky II and III)
appear to be a promising solution reducing the need of bone grafting. Our experience
reflects early results reported in published studies.
AS1-191 A RADIOLOGICAL REVIEW OF HIP CENTRE OF ROTATION IN REVISION TOTAL HIP
ARTHROPLASTY, TRABECULAR METAL VERSUS NON TRABECULAR METAL
Keogh CJ, O'Brien C, Harty J
Department of Orthopaedics, Cork University Hospital, Cork, Ireland
Introduction/objectives: Total Hip Arthroplasty (THA) is a very
successful procedure. Unfortunately, prostheses have a lifespan. Revision THA is
becoming increasingly common but can present a considerable challenge. These
problems can also complicate primary procedures. Recent developments to improve
outcomes include the development of large trabecular metal (TM) acetabular cups and
augments. There is a paucity of data on the benefit of these new techniques.
Methods: A single centre retrospective review consisting of a
radiological review of post op revision THA AP pelvis. Population and data
collection was performed using the Irish National Orthopaedic Register (INOR) and
data from a previous project. The X-rays were calibrated and scaled. We used a
technique developed by Fessy et al to measure the centre of rotation (COR) of the
hip. We then compared our study to that of a study measuring the COR of healthy
native hips.
Results: 127 revision THA procedures analysed. 43 had TM augments, 7 had
TM cup alone, 71 did not contain TM and 6 had missing post op radiographs. Native
COR calculated by Fessy et al showed a mean horizontal (X) axis 33.6 mm (SD 5.74)
and a vertical (Y) axis 16.4 mm (SD 4.67). TM Augments had a mean X axis 29.2 mm (SD
7.9) and Y axis of 21.5 (SD 8.4). TM Cups alone had a mean X axis 27 mm (SD 6.9) and
Y axis 22 mm (SD 10.18). Non TM revisions showed a mean X axis of 29 mm (SD 3.9) and
Y axis 17.9 (SD 5.9).
Conclusions: The vertical axes of both TM augments and TM cups alone
showed considerable deviation from the norm. Non TM THA was the only revision THA
with a standard deviation within acceptable physiological range. Findings suggest
that more needs to be done to attain a natural COR in TM revision THA.
AS1-89 REVISION TOTAL HIP ARTHROPLASTY USING ACETABULAR RECONSTRUCTION
CAGE
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Recently, satisfactory results have been
reported about using GAP II implant in revision total hip arthroplasty (RTHA). In
current study, we investigated the short-term results of these implants for
acetabular reconstruction in RTHA.
Methods: There were 122 patients (76 males and 46 females) aged 54.2 ±
23.1 years underwent RTHA utilizing Gap II prosthesis. Structural allograft (bulk),
morselized allograft and TMT augment were used in 27, 41 and 9 hips, respectively. A
cemented polyethylene cup implanted with cement in Gap II implant. Patients were
examined clinically and radiographically before and after the operation. Paprosky
system was used to classify the bone defects. Pre- and postoperatively, modified
Harris Hip score (MHHS) was completed for all patients. The cup stability was
assessed using plain x-rays of the hip. Patients were followed for 24.5 ± 11.3
months.
Results: There was no case of infection, deep venous thrombosis,
pulmonary thromboembolic disease and dislocation. In one patient, motor-car accident
resulted in cage failure and subsequent RTHA. Modified HHS was 49.7 ± 13.1
pre-operatively which significantly increased up to 87.5 ± 14.5, postoperatively
(p<0.001).
Conclusions: Acetabulum reconstruction in RTHA requires bone graft for
bone defects and placing a metal cage to support the acetabulum and grafts. The
characteristics of the Gap II, a hook for obturator foramen and extension plate
effectively are helpful in anatomically placement of the acetabular component and
more stabilized prosthesis. These features make GAP II to be associated with
satisfactory outcomes in RTHA.
AS1-223 FUNGAL PERIPROSTHETIC HIP JOINT INFECTIONS
Peirano F
Complejo Medico Policial Churruca-Visca, Buenos Aires, Argentina
Introduction/objectives: Fungal infections in joint replacements are not
common and currently there is no international protocol for their treatment,
although, nowadays the most frequent surgical treatment is the 2-stage exchange
arthroplasty. We present a case of cemented THA infected by Candida Tropicalis, in a
69 year-old male, who had no immunity decreased and no diabetes, its solution in
2-stage exchange arthroplasty, free infection, with 18 months of follow-up.
Methods: The patient is a 69 year-old male, with antecedent of cemented
THA in 2013, revisions of the cup for instability, VRS 110. We carried out biopsy
discovering in the histology the presence of particles of yeast and positive
cultures for Candida Tropicalis, reason for which we did the revision in 2-stage.
First step, with implantation of impregnated cement spacer hip with Amphotericin B
and Vancomicin, after 6 months of specific treatment with blood test showing normal
levels and new negatives biopsies, which allowed us to start with the 2 step,
placement of a prosthesis of cementless revision with long distal-fixed stem.
Results: 20 cases of fungal infection were reported from 1979 to 2009 in
THA, of which 6 were treated 2-stage exchange arthroplasty and 14 ended up with
Resection arthroplasty. In only 2 cases the causal germ was Candida Tropicalis. The
patient in question, with the treatment in 2-stage exchange, is free from infection,
with a follow-up of 18 months, normal blood levels, no pain and complete mobility of
the hip. He walks without crutches and no limp.
Conclusions: Although this is only one case, it coincides with scarce
bibliography, we can say that the treatment in 2-stage exchange arthroplasty was the
correct treatment and the systemic antifungal therapy for 6 months.
AS2 Award Abstracts: Oral
AS2-112 RESULTS OF THE AUSTRIAN ULTRASOUND SCREENING PROGRAM FOR DEVELOPMENTAL
DYSPLASIA OF THE HIP
Thallinger C1, Pospischill R1,
Ganger R1, Radler C1, Krall C2, Grill
F1
1Orthopädisches Spital Speising, Wien, Austria; 2Meduni Wien,
Wien, Austria
Introduction/objectives: Diagnosis and early treatment of developmental
dysplasia of the hip have always been an issue of discussion. In 1992 a nationwide
general ultrasound-screening program using Graf's technique has been introduced to
detect developmental dysplasia of the hip (DDH) in Austria.
Methods: The effects on the rate of both operative and conservative
treatments and the influence on the number of admissions to hospital due to DDH were
investigated. For this retrospective study all cases of DDH documented in Austrian
hospitals from 1992 to 2008 were included. The Austrian Ministry of Health's
database was used to extract documented diagnoses and treatments.
Results: Since the introduction of the screening the rate of patients
who needed pelvic surgery due to DDH has decreased by 46%, while the rate of open
reductions is as low as 0,23 per 1000 live births. The rate of patients who needed
conservative treatment dropped from 8% to 2,6%. Regarding the admission of patients
to hospital this quota decreased from 9,5 to 3,6 per 1000 live births. All mentioned
results gained statistical significance.
Conclusions: It was shown, that a standardized and nationwide general
ultrasound-screening program can reduce both operative and conservative treatment
rates in comparison to a clinical- and radiograph based screening routine.
AS2-405 DOES CARTILAGE COMPOSITION CHANGE AFTER JOINT PRESERVING HIP SURGERY
FOR FAI - PRELIMINARY DATA OF A PROSPECTIVE COMPARATIVE LONGITUDINAL STUDY USING
DELAYED GADOLINIUM ENHANCED MRI OF CARTILAGE (dGEMRIC) AT 3 T
1Inselspital, Universität Bern, Klinik für Orthopädische Chirurgie und
Traumatologie, Bern, Switzerland; 2Sonnenhof, Abteilung für Radiologie,
Bern, Switzerland
Introduction/objectives: Delayed gadolinium enhanced MRI of cartilage
(dGEMRIC) allows a ‘monitoring’ of glycosaminoglycan content of cartilage and can be
used as biomarker for osteoarthritis. We aimed to assess whether changes in T1
values occur 1 year after FAI surgery compared to patients with non-operative
treatment and if changes correlate with clinical short-term outcome.
Methods: IRB-approved prospective, comparative, longitudinal study of
two groups (61 hips). Hips were assigned to the ‘operative’ (open/arthroscopic
correction) respectively to the ‘non-operative’ group. At baseline, groups were
comparable regarding Tönnis score, WOMAC and T1 values. Patients had baseline and
1-year follow-up i.v. dGEMRIC scans with the same 3 T magnet (0.2 mmol/ml per kg
Gd-DTPA). Radial T1 maps were reformatted from a 3D T1 map. Central, peripheral
femoral (12 ‘hour’ positions) and acetabular (10 ‘hour’ positions) T1 values were
measured per hip. Baseline and 1-year follow-up WOMAC scores were obtained.
Statistical analysis included paired/unpaired Student's t-Tests
(p<0.05).
Results: Acetabular T1 values decreased significantly (p<0.05) in
17/20 (85%) zones and in 21/24 (88%) of femoral zones in the operated group. In the
non-operative group, no acetabular zone and 2/24 (8%) femoral zones presented with a
significant drop. After 1 year the WOMAC significantly improved (58 ± 42 to 33 ± 42;
p = 0.007) for the operative group, while there was no significant change (55 ± 45
to 48 ± 50; p = 0.825) for the non-operative group.
Conclusions: FAI surgery led to a decline in cartilage composition on
MRI after 1 year despite significant clinical improvement. This decline may result
from postoperative inflammation or from altered biomechanic stress and requires
longer follow-up.
AS2-349 30 YEAR FOLLOW-UP AFTER BERNESE PERIACETABULAR OSTEOTOMY
Lerch T, Tannast M, Steppacher S, Siebenrock
K
Inselspital Universitätsspital, Bern, Switzerland
Introduction/objectives: Periacetabular osteotomy is a surgical
treatment of developmental dysplasia of the hip. We evaluated the mean 30-years
results of this procedure of the first 63 patients (75 hips) operated at the
institution where this procedure had been developed.
We determined the (1) cumulative 30-year survivorship of symptomatic patients treated
with this procedure, determined the (2) clinical and (3) identified factors
predicting the need for total hip arthroplasty (THA).
Methods: We retrospectively evaluated the first 63 patients (75 hips)
who underwent periacetabular osteotomy between 1984-1989. Pre-Operatively 24%
presented with advanced grades of osteoarthritis. 31% had previous operations to
attempt sufficient coverage.
(1) We calculated the cumulative survivorship of the hip according to Kaplan-Meier
with conversion to THA as the only endpoint. In addition, we assessed the (1) Merle
d'Aubigné and the Harris Hip Score and assessed (3) A Coxregression model was used
to calculate predictors for failure and a prognostic model
Results: (1) The cumulative survivorship of the hip at 30-years was 32%
(95% confidence interval 17-42%). 40 hips (53%) had subsequently undergone THA (2)
The mean Merle d'Aubigné score of the surviving hips was 16 (SD 2), which was
significantly higher compared to the 10 years, and 20-years results and even to the
pre-operative value. (3) The following predictors for failure were identified: age,
decreased pre-operative external rotation, pre-operative limb, positive
pre-operative impingement sign, pre-operative radiographic osteoarthritis.
Conclusions: Thirty years postoperatively, almost one third of hips
undergoing PAO for DDH can be preserved. Periacetabular osteotomy is an effective
technique for treating symptomatic developmental dysplasia.
AS2-357 INTRAOPERATIVE TWO-STAGE EVALUATION OF MUSCLE CONTRACTURES IN CROWE
TYPE IV HIPS IN TOTAL HIP ARTHROPLASTY
Bilgen öF, Yaray O, Mutlu M
Private Medicabil Hospital, Bursa, Turkey
Introduction/objectives: Most important factors for functional hip
arthroplasty in Crowe type IV hips are maintaining soft tissue balance and
prevention of muscle contractures after reduction of the hip.
Methods: Prospectively 64 patients (75 hips) underwent THA were
evaluated intraoperatively for muscle contractures between February 2012 and March
2015. After acetabular implantation, femoral osteotomy was performed according to
limb length discrepancy. Distal part of femur was prepared by rasp and hip was
reduced then tensor facia lata, m. rectus femoris, m. sartorius, hamstrings and
adductor muscles were evaluated and contractures were released. Distal and proximal
parts of femur were joined by rasp and hip reduced again. M. iliopsoas and abductor
muscles were evaluated and contractures were released.
Results: Mean follow up was 42 months. Pre-Operative and postoperative
Harris hip scores were 52 and 87 respectively. Pre-Operative mean limp length
discrepancy was 4.2 cm and it was lesser then 1 cm postoperatively. After reduction
of distal part of femur tensor facia lata were released in 67 hips (89%), m. rectus
femoris in 54 hips (72%), m. sartorius in 15 hips (20%), and hamstring muscles in 8
hips (10%). M. adductor longus were released percutaneously in 8 hips (10%). 6 of
these m. pectineus, adductor berevis and proximal part of adductor longus were also
released. After reduction of hip m. iliopsoas was released in 36 hips (48%) and
abductor muscles were released in 4 hips (5%).
Conclusions: It is challenging to pinpoint the main muscle causing
contraction as the other muscles acting on the hip joint have similar secondary
functions. The described method would provide better and specific restoration of
function of the muscles in hypoplasic hemipelvis in DDH patients.
AS2-411 INTRODUCTION OF NEW ACETABULAR DESIGNS DOES NOT INFLUENCE RISK OF
EARLY FAILURE IN HIP ARTHROPLASTY
Mohaddes M1, Nemes S2, Kärrholm
J1
1Department of Orthopaedics, Swedish Hip Arthroplasty Register,
Gothenburg, Sweden; 2Swedish Hip Arthroplasty Register, University of
Gothenburg, Gothenburg, Sweden
Introduction/objectives: New prostheses designs are being introduced in
order to further improve the outcomes after hip arthroplasty. According to a recent
study there is an increased risk for early revision surgery when new implants are
introduced in Finnish hospitals. We analysed the risk of early revision during the
implementation phase of new cup designs in Sweden.
Methods: All THAs and first time cup revisions performed during years
1993-2011 were identified in the Swedish Hip Arthroplasty Register. Cup designs not
strongly reminiscent of any precursor cups (n = 52,903) were selected for this
analysis. All cups were given a number based on the order in which the cup had been
inserted in each hospital. The order number of the cups was analysed in a regression
model. Adjustments with and without splines were made for potentially confounding
covariates. Revision within 2 years (n = 902) was used as end-point.
Results: The adjusted logistic regression analysis showed no increased
risk of early revision surgery within 2 years during the implementation phase of new
cups (p = 1.0). According to the splines there was an increased risk for the first
120 cups and in cups being implanted with order number 280-600. Using aforementioned
numbers as cut-off values did not result in any significant changes in risk of
revision within two years (p>0.18).
Conclusions: Our findings indicate that risk for early revision does not
increase when new acetabular designs are being introduced in Sweden. The structured
and step-wise introduction of new prosthesis design, facilitated by the annual
feedback given from The Swedish Hip Arthroplasty Register to individual hospitals in
Sweden might partly explain the discrepancy between our findings and the previous
report from the Finish Arthroplasty Register.
AS2-86 BILATERAL TOTAL HIP ARTHROPLASTY: ONE-STAGE VERSUS TWO-STAGE
PROCEDURE
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Despite several studies, controversies
prevailed about the rate of complications following one-stage and two-stage
bilateral total hip arthroplasty (THA). In current prospective study, we compared
the complications and functional outcomes of one-stage and two-stage procedures.
Methods: One hundred and eighty patients (ASA class I or II) with
bilateral hip osteoarthritis were assigned randomly to two equal groups. Two groups
were matched in term of age and sex. All of the surgeries were performed through the
Harding approach using uncemented implants. In two-stage procedures, surgeries were
performed with 6 months to one year interval. All patients were evaluated one year
postoperatively.
Results: The Harris hip score averaged 84.1 ± 12.6 and 82.6 ± 15.3 in
one-stage and two-stage groups, respectively (p = 0.528). The hospital stay was
significantly longer in two-stage group (9.8 ± 1.1 versus 4.9 ± 0.8 days). The
cumulative haemoglobin drop and number of transfused blood units were the same. One
patient in each group developed symptomatic deep venous thrombosis and managed
successfully. There was no patient with perioperative death, pulmonary embolism,
infection, dislocation, periprosthetic fracture or heterotrophic ossification. No
patient required reoperation. Two patients in one-stage group developed unilateral
temporary peroneal nerve palsy resolved after 3 and 4 months.
Conclusions: The current study showed that one-stage bilateral THA can
be used successfully for patients who require bilateral hip arthroplasty without
increased rate of complications. The functional and clinical outcomes are comparable
and hospital stay is significantly shorter. However, the authors recommend to
perform one-stage bilateral THA for healthy patients with ASA class I or II.
AS2-218 CEMENT-IN-CEMENT STEM REVISIONS. THE SWEDISH EXPERIENCE
1Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute
of Clinical Sciences, Gothenburg, Sweden; 2Swedish Hip Arthroplasty
Register, Gothenburg, Sweden; 3Princess Elizabeth Orthopaedic Centre,
Exeter, UK
Introduction/objectives: Stem revision with retention of the old cement
mantle (cement-in-cement revision) in cases with an intact cement/bone interface is
an appealing option. There has been an increasing use of this technique. In 2014
this cement-in-cement technique was used in 10% of all stem revisions reported to
the Swedish Hip Arthroplasty Register (SHAR). The technique has previously been
described and published with some excellent midterm results.
Methods: We analysed the outcome of cement-in-cement stem revisions
reported to the SHAR during years 2001-2014. Since 2001 1058 cement-in-cement
revisions (study group), performed with a standard Exeter stem or a Lubinus stem
were reported to the SHAR. Re-revision of the stem due to all causes was used as
secondary outcome. Survival analysis using Kaplan-Meier was performed. The study
group was compared to the traditional cemented revisions as reported to the
SHAR.
Results: Survival with re-revision due to all causes at 8 years in the
cement-in-cement group was 87% as in the traditional cemented revisions group. The
survival of the stem with re-revision due to aseptic loosening at 8 years was 95% in
both groups.
Conclusions: There are no differences in risk of re-revision between the
cement-in-cement stem group and the traditional cemented stem revisions in the
Swedish Hip Arthroplasty Register. Cement-in-cement revisions had a slightly higher
re-revision rate in the SHAR if compared to the available literature. We believe
that cement-in-cement revision, with its shorter operation time and the potential
for less peri-operative complications could be an attractive option in selected
cases with intact cement/bone interface.
AS2-184 POSSIBILITY OF DRR IMAGES AS A SUBSTITUTE FOR X-RAY IMAGES
Nakamura H, Koyama H, Nishikino S, Hoshino H,
Matsuyama Y
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine,
Hamamatsu-City, Shizuoka, Japan
Introduction/objectives: Digitally reconstructed radiographs (DRR) are
projection images created from CT images. DRR images are often utilized for
pre-operative planning and for clinical studies, substituting X-ray images. However,
while the X-ray image is a cone beam projection image, DRR image is a parallel
projection image by ray trace method, meaning that two images are strictly
different. The purpose of the study was to analyse the differences of the
radiographic parameter values between these two images.
Methods: The X-ray and CT images of 45 hips (45 patients) were analysed.
Virtual three dimensional pelvic bone models were established from DICOM data of CT
images by the software for THA pre-operative three-dimensional planning (Zed Hip,
LEXI, Tokyo). The inclination and rotation of the pelvic bone models were matched to
those of pelvis X-ray images to create DRR images. Acetabular coverage rate (total,
anterior 1/2 (A1/2), posterior 1/2 (P1/2)), CE angle, Sharp's angle, AHI and p/a
ratio on X-ray and DRR images were measured by ACX dynamics, which enables
evaluation of the acetabular parameters using a plain AP radiograph of pelvis. The
differences of the parameter values between X-ray and DRR images (DRR - XP) were
investigated.
Results: The averaged differences between the two images (DRR - XP) were
1.6 ± 3.5% for total, −0.3 ± 4.7% for A1/2, 3.5° ± 3.7% for P1/2, 2.9 ± 2.2°for CE
angle, −0.6 ± 1.9° for Sharp's angle, 0.8 ± 2.3% for AHI, and 0.3 ± 0.3 for p/a
ratio.
Conclusions: The comparison between the X-ray and DDR images revealed
that the values of posterior coverage rate and CE angle tended to be greater in the
DDR images and should be taken into consideration when DDR images are being used as
an alternative for X-ray images.
OP01 Positioning
OP01-287 PRE-OPERATIVE POSITIONING AND INTRAOPERATIVE MOTION ERRORS DURING
TOTAL HIP ARTHROPLASTY IN LATERAL POSITION
Introduction/objectives: Component malposition following total hip
arthroplasty (THA) can lead to serious complications especially dislocation. In
lateral positioning, acetabular component implantation with standard manual-guided
technique can cause the errors from both pre-operative positioning and
intraoperative motion.
The objectives of this study are to identify the errors from pre-operative
positioning and intraoperative motion that were detected by fluoroscopy and
imageless computer-assisted navigation, respectively.
Methods: A prospective descriptive study was conducted in 40 patients
who underwent THA in lateral positioning with imageless computer-assisted navigation
in Maharat Nakhon Ratchasima hospital, from June 2015 to January 2016. Pre-Operative
positioning errors were detected and corrected by fluoroscopy with surgical bed
tilting. After acetabular cup was implanted with standard manual-guided technique,
imageless computer-assisted navigation was applied to identify the deviated degree
of cup position from desired position (40o inclination and 10o anteversion).
Intraoperative motion error was the difference of the degrees between final cup
position that measured by imageless computer-assisted navigation and pre-operative
positioning error.
Results: Pre-Operative errors in coronal, horizontal and sagittal planes
that were detected and corrected by fluoroscopy are 2.70 (range 0.9-8, SD 1.71),
3.43 (0.7-10, 2.33) and 5.49 (1-12, 2.89) degrees, respectively. Pre-Operative error
outlier in sagittal plane more than 5 and 10 degrees were found in 23 (57.5%) and 4
(10%) cases, respectively. Intraoperative errors (after corrected by fluoroscopy) in
cup inclination and anteversion were 2.87 (0-8, 2.10) and 5.18 (0-14, 3.32) degrees.
Intraoperative error outliers in anteversion more than 5, 8 and 10 degrees were
found 21 (52.5%), 8 (20%) and 5 (12.5%) cases, respectively.
Conclusions: Pre-Operative positioning and intraoperative motion errors
were found in THA with lateral position especially in sagittal plane which leading
to the errors in cup anteversion position.
OP01-107 SIMPLE INTRAOPERATIVE TECHNIQUE FOR LIMB LENGTH MEASUREMENT DURING
TOTAL HIP ARTHROPLASTY
1University Hospital of Ioannina, Ioannina, Greece; 2Attikon
University Hospital, Athens, Greece
Introduction/objectives: Limb length discrepancy (LLD) after total hip
arthroplasty (THA) is a common problem which cannot be completely resolved. Many
techniques have been described in order to minimize postoperative LLD, but most of
these techniques are difficult to be applied. The ideal technique must be simple and
accurate. The simplest technique, using a suture tied on the skin has well known
limitations, but its accuracy has not been evaluated before.
Methods: A prospective study including 60 THAs was conducted. In all
surgeries, the intraoperative measurement of limb lengthening was performed using a
suture tied on the skin of the lateral pelvis. The accuracy of this technique and
correlation between intraoperative and postoperative radiological measurements of
lengthening were evaluated.
Results: The mean pre-operative LLD was −7.5 mm while the mean
postoperative LLD was 1.58 mm. The accuracy of this technique, defined as the mean
difference between the intraoperative and postoperative measurements was 1.8 mm. A
strong correlation between these two measurements was noticed (r = 0.86).
Conclusions: The accuracy and correlation index of this simple technique
were similar to those of other techniques. The studied technique is quite accurate
when attention is given to certain details.
OP01-167 CUP POSITION INFLUENCE ON RESULTS OF TOTAL HIP ARTHROPLASTY
Tikhilov R, Shubnyakov I, Boyarov A, Denisov
A
Vreden Russian Institute of Traumatology and Orthopaedics, Saint Petersburg, Russian
Federation
Introduction/objectives: Along with the primary surgery performed
increases the number of revision procedures. It means that large number of technical
errors occurs during the implantation, which leads to incorrect biomechanics of the
hip joint endoprosthesis.
The aim of our study was to determine the influence of correct position of the
acetabular component on the function of the hip joint endoprosthesis.
Methods: We performed evaluation of medical documentation, radiographs
and CT scans of 997 patients, which underwent primary THA during 2011 year and 47
patients with minimal follow-up 8 years.
We performed X-ray measurement and mathematical analysis of these data.
Results: The statistical analysis of our data shows that using the cup
guide surgeons tend to install the cup into a more horizontal position with a
tendency of increasing the anteversion of the cup. Comparative analysis of patients
operated with standard approach and with MIS approach showed a greater average angle
of inclination in patients after MIS. There was no correlation between body mass
index and the angles of inclination and anteversion of the cup, although there is a
slight tendency towards more vertical positioning of cups with the increase of the
BMI.
The analysis of measurements in patients with femoral component head dislocations
showed that the angles of inclination and anteversion of the acetabular component
were within acceptable limits, but there is a tendency to a more vertical
positioning.
Conclusions: Thus, the correct positioning of the acetabular component
arthroplasty can improve efficiency and survival rate of implants.
OP01-81 IPAR (INFERIOR EDGE OF THE POSTERIOR ACETABULAR RIM) AND ITS RELEVANCE
IN POSITIONING OF THE CUP
Jose Edakalathur J, Bhaskar D, Board T, Rajpura A,
Thomas S
Wrightington Hospital, Wigan, UK
Introduction/objectives: The predicted socket size and position pre-op
is very often different from what is achieved intra-op which in turn results in a
variation in leg length and offset. This is often thought to be due to errors in
assessment of magnification of the radiographs. Our study looked at acetabular
template sizes based on two positions, the IPAR and teardrop and correlated it with
Post-op cup size and position, to predict the ideal position for placement of the
cup.
Methods: Pre-operative radiographs of 44 consecutive patients who
underwent uncemented Total Hip Replacement were templated for socket size in two
different positions the tear drop and the (IPAR). The relative position of these two
landmarks were also assessed. A final templating exercise positioned the socket in
the exact position as achieved on post-op radiographs. These template sizes were
compared to actual implant size.
Results: In 86% of radiographs IPAR and teardrop were at different
level. There was a statistically significant difference between templated socket
size at IPAR position (mean 54.9 mm) and teardrop (mean 49.3 mm) with mean
difference 5.56 mm (P<0.001). The mean implanted cup size (52 mm) was 2.9 mm less
than the IPAR position size (P = 0.002) and 2.3 mm larger than the tear drop
position size (P = 0.006). When the final implanted position was used to define
position, there was no difference between templating and actual cup. The most common
position of the inferior cup post-op was midway between IPAR and teardrop.
Conclusions: This study suggests that inaccuracy in predicting
acetabular cup size is due to error in template position and not radiographic
magnification. It also defines that the ideal position of placement of inferior edge
of cup is midway between IPAR and tear drop, to improve accuracy of cup size.
OP01-346 MAASH TECHNIQUE. A NEW PHILOSOPHY
Salvador A, Broch A, Delgado F
Sant Celoni Hospital, Sant Celoni, Spain
Introduction/objectives: Two main concerns among hip surgeons are
present in many meetings following a total hip arthroplasty (THA), leg length
discrepancy (LLD) and dislocation. Surgical expertise, better devices and improved
materials have not avoided those issues, leading to poor outcomes in these patients.
We present a new way to perform primary THA, we called MAASH technique. Just
following the spatial disposition of superior iliofemoral ligament (SIFL) and
pubofemoral ligament (PFL) there is an internervous zone in the anterior hip capsule
we coined as “MAASH window” that we excise to implant a THA preserving the native
ligament construction. With this simple and comprehensible surgical maneuver, we
achieved a major stability and consistency values of LLD. We would say that, this
new philosophy, allow orthopedic surgeons to treat two issues (LLD and THA
stability) in one step.
Methods: Our procedure was developed since November 2007 and we describe
three different phases, Pre-MAASH, Regular MAASH and Last year procedure. We report
our 243 cases (mean follow-up 38.7 months, 1-96 months) of primary THA carried out
performing the MAASH window following MAASH technical details. Etiologies in those
243 cases were; 198 hip osteoarthritis (OA), 32 femoral head necrosis, 2 Perthes
disease sequel, 6 acetabular dysplasia grade II, 2 rheumatic disease and 3 coxa
protrusio. Indications for this procedure include, Hip Osteoarthritis (primary or
secondary) not for Crowe III or IV stages, Femoral Neck Fractures and it is
especially appropriated for those patients with higher risk of dislocation.
Results: Brief statistical data and complications are presented
regarding, LLD, Implant positioning, Timing of surgical procedure, Length of
Hospital Stay and complications.
Conclusions: MAASH technique is not a new approach. It is a new way to
implant a THA without violating the two main ligament structures of the anterior hip
capsule. Through the “MAASH window” we can perform a THA avoiding hip dislocation
obtaining consistency values of LLD around 4.4mm with no dislocations. What's new in
this paper? To report a new way to understand THA procedure, respecting the anatomy
of the anterior hip capsule, pointing out that LLD and THA instability are two
issues that would be solved by the same surgical maneuver. Would I be a new
philosophy?
OP01-429 THE ROOF STEP CUT TECHNIQUE FOR BONY RECONSTRUCTION IN ACETABULAR
ROOF DEFICIENCY - FOLLOW UP
Csernatony Z1, Gyorfi G1,
Huszanyik G2, Mano S3
1Department of Orthopaedics, Debrecen, Hungary; 2Department of
Traumatology, Kenezy Hospital, Debrecen, Hungary; 3Biomechanics
Laboratory, Debrecen, Hungary
Introduction/objectives: In many cases during hip replacement after
developmental dysplasia of the hip, the acetabulum is oval shaped, and the original
bulk bone grafting techniques do not provide enough coverage for the acetabular cup.
In these cases authors use the previously described Roof Step Cut technique as a
solution for the problem. Below authors analyse the short to mid-term results of the
method.
Methods: Authors applied the Roof Step Cut technique in 37 hip
replacements since 2008 (35 female, 2 male), with an average 34, 4 (3-117) month's
follow-up. Authors performed the pre-operative Hartofilakidis classification of the
hip joints. Analysing postoperative X-rays authors determined the coverage of the
acetabular cup by the graft. During follow-up standard AP pelvic X-rays were
analysed, especially the fusion of the host-graft junction. Authors also evaluated
the complications.
Results: Authors applied the Roof Step Cut technique in 37 cases, 13
Hartofilakidis A, 21 Hartofilakidis B, 3 Hartofilakidis C. Authors implanted
cementless acetabular cup in 35 cases, cemented cup in 2 cases, additional
stabilizing screw was inserted in 18 cases. The average coverage of the cup by the
graft is 24%. Analysing the X-rays, bony consolidation in the host-graft junction
can be seen in all the cases, no malunion or graft resorption occurred. Among
complications wound healing problems was seen in 3 patients as prolonged discharge,
superficial or deep infections did not occur. Revison surgery had to be performed
because of aseptic cup loosening in 1 patient, and due to dislocation of the
prosthesis in another. All of the patients are satisfied with the postoperative
result.
Conclusions: The Roof Step Cut technique can be applied in
Hartofilakidis type A, B or C dysplasia. Authors' results up to now are encouraging,
and they recommend the technique for acetabular roof deficiency.
OP01-185 FEMUR FIRST TECHNIQUE: A SMART NON-COMPUTER-BASED SURGERY TO ACHIEVE
THE COMBINED ANTEVERSION IN PRIMARY TOTAL HIP ARTHROPLASTY
Loppini M, Astore F, Caldarella E, Della Rocca A,
Mazziotta G, Traverso F, Grappiolo G
Humanitas Research Hospital, Rozzano, Milan, Italy
Introduction/objectives: The relevance of component orientation to
prevent dislocation and impingement following total hip arthroplasty (THA) has been
widely accepted. We investigated the use of a non-computer-based surgery to achieve
a combined anteversion (CA) between 25° and 50° with an acetabular inclination (AI)
between 30° and 50°.
Methods: Clinical and radiographic assessments were performed before and 3 months
after THA. Radiographic assessment was performed in standing position with the EOS
2D/3D radiography system. 3D images were used to measure pre-operative anterior
pelvic plane angle (APPA), postoperative acetabular anteversion (AA) and AI,
pre-operative femoral (FA) and postoperative stem antetorsion (SA). Clinical
assessment was performed with Harris Hip Score (HHS).
Results: We prospectively enrolled forty consecutive patients (40 hips)
who underwent primary THA with an average age of 61 years (36-84). In femur first
technique, the cup was positioned relative to the femoral stem. Average HHS
increased from 43 ± 5 (37-52) pre-operatively to 97 ± 6 (86-100) at the last
follow-up (P<0.0001). Average CA and AI were within the targeted range in 92.5%
with values of 38° ± 9° (12°-55°) and 40° ± 6° (30°-58°) respectively. Average
pre-operative FA was 11° ± 14° (-21° to 45°), whereas the average postoperative SA
was 9° ± 10° (-23° to 31°) (P = 0.71). Average CA was 34° ± 8° (23°-51°) in the
group with SA up to 9° and 41° ± 9° (12°-55°) in the group with more than 10° of SA
(P = 0.002). Relationship analysis showed no correlation between the CA and APPA
values (r = 0.26, P = 0.87).
Conclusions: Femur first technique provides a proper orientation of
prosthetic components during THA, and the position of the cup is not affected by the
pre-operative pelvic tilt.
OP02 Approach
OP02-437 DOES SURGICAL APPROACH AFFECT PERIOPERATIVE MORBIDITY OF SAME-DAY
BILATERAL TOTAL HIP ARTHROPLASTY?
Poultsides L, Oi K, Memtsoudis S, Do H, Su E, Sculco
T, Alexiades M
Hospital for Special Surgery, New York, USA
Introduction/objectives: We compared (1) clinical characteristics; (2)
procedure and operating room time, LOS, destination post discharge; (3) blood
transfusion, in-hospital complication and 30-day mortality rate, and (4) total
in-hospital charges between patients undergoing either direct anterior (DA) or
posterior (P) same-day Bilateral THA (SDBTHA).
Methods: Between 1/2010 and 12/2015 demographics, comorbidity, Deyo
index, LOS, primary diagnosis, blood transfusion rate, in-hospital complication, and
destination post discharge of SDBTHA patients were recorded. Univariate analyses
were conducted using Wilcoxon rank-sum test and Fisher's exact test.
Results: 87 patients underwent A and 170 P BTHA. Groups were similar in
age (A: 56.1 ± 11.3 vs. P: 55.1 ± 13.0; p = .8), Deyo index (A: 0.11 ± 0.36 vs. P:
0.21 ± 0.9; p = .87), and female gender (A: 60.9% vs. P: 52.4%; p = .23). Procedure
time-minutes- (102.2 ± 41.6 vs. 152.0 ± 159.9; p<.001) and LOS (3.1 ± 1.1 vs. 4.3
± 1.5; p<.001) were lower in A group, which was more frequently discharged to
home (42.7% vs. 28.6%; p = .02). No difference was observed in blood transfusion (A:
60.9% vs. P: 57.1%; p = .6), local (0.0% vs. 0.0%; p = 1.0), minor (A: 10.3% vs. P:
12.9%; p = .7), major systemic (A: 0.0% vs. P: 0.6%; p = 1.0) complications, and
30-day mortality rate (0.0% vs. 0.0%; p = 1.0). Total in-hospital charges ($) were
lower in A group (90.683 ± 15.181 vs. 95.647 ± 17.274; p = .005).
Conclusions: Perioperative complication is low and comparable between
the DA and P Bilateral THA. Our results suggest that the DA approach is a safe
alternative to the posterior equivalent and is associated with shorter procedure
time and hospitalization, more frequent discharge to home, and lower total
in-hospital charges, providing thus a potential cost-effective advantage in an era
of cost containment.
OP02-173 MIDTERM IMPLANT SURVIVORSHIP OF THE ACCOLADE TMZF HIP STEM; IS THERE
A LEARNING CURVE OR EFFECT OF DIFFERENT SURGICAL APPROACHES ON SURVIVAL
RATE?
van den Hout J, Koenraadt K, Wagenmakers R, Bolder
S
Amphia Hospital, Breda, The Netherlands
Introduction/objectives: The Accolade TMZF (Stryker Orthopaedics,
Mahwah, USA) is an uncemented tapered hip stem. The TMZF alloy allows for a better
elastic modulus than other titanium alloys. Proximal circumferential plasma spray
and a PureFix HA coating should allow for a reliable mechanical engagement in the
bone. Survival data of this particular stem are limited in the literature. The
primary goal of this study is to report the mid-term survival of this prosthesis in
a large cohort, with a minimal follow up of 5 years. Additionally, the potential
effects of a learning curve and surgical approach on survival rates are
assessed.
Methods: We started using the Accolade TMZF stem in March 2009. From
this point until February 2011, all patients were included for the current analysis.
We performed 981 THA with the Accolade TMZF stem (mean survival time of 6.8 years).
Procedures were done by 12 surgeons (4-296 hips) using a posterolateral (87.9%),
anterolateral (7.6%) or direct anterior (4.5%) approach. We analysed the learning
effect of those surgeons who did over 100 THA (N = 5) by comparing the survival of
their first 50 hips with their next 50 hips.
Results: At 5 years the Kaplan-Meier implant survivorship was 97.1%
(revision for all reasons) and 98.1% with aseptic loosening as endpoint. No learning
effect (P = 0.66) was found. The direct anterior approach group showed a
significantly (P<0.001) lower survival (81.6%) compared to the anterolateral and
posterolateral groups (98.6% and 97.8%).
Conclusions: The Accolade TMZF stem showed good midterm survival rates and was
implemented at our institution without a learning curve. The introduction of the
direct anterior approach in our posterolateral oriented group is unfavourable on the
survival data.
OP02-182 POSTEROLATERAL VERSUS DIRECT ANTERIOR APPROACH FOR THA (POLADA). IS
THERE A DIFFERENCE IN MUSCLE DAMAGE?
Rykov K1, Ten Have B1, Knobben
B1, Meys T1, Sietsma M1, Reininga
I2, Bulstra S2
1Martini Hospital, Groningen, The Netherlands; 2University
Medical Center Groningen, Groningen, The Netherlands
Introduction/objectives: The anterior approach for total hip
arthroplasty (THA) uses intermuscular planes and thus might result in less muscle
damage when compared to conventional approaches for THA.
A prospective randomised controlled trial between the anterior and posterolateral
approach was conducted to visualize differences in muscle damage.
Methods: 46 patients participated in the study. Muscle area and degree
of muscle atrophy, measured according to the Goutallier classification, of twelve
muscles were measured pre-operatively and one year postoperatively by means of MRI.
Mann Whitney U-tests and Wilcoxon signed rank tests were performed to analyse the
differences between the approaches. A p-value of <0.05 was considered to be
significant.
Results: Postoperative decrease in muscle area was found for the
piriformis, obturator internus and obturator externus in both approaches.
Additionally, the area of sartorius declined in the anterior group and the iliacus
and the quadratus femoris in the posterolateral group. Muscle atrophy increased
significantly in the piriformis, obturator internus and obturator externus for both
approaches. The tensor fascia latae showed an increase in muscle atrophy in the
anterior approach group.
Significant differences between the two approaches for both muscle area and degree of
atrophy were only found for the obturator internus and obturator externus.
Conclusions: Muscle damage measured with MRI did not show major
differences between the anterior and posterolateral approach. Future studies should
assess the influence of the postoperative muscle damage and atrophy on patients'
functional outcome.
OP02-374 ANTEROLATERAL APPROACH PROTECTS GLUTEAL MUSCLES COMPARED TO
TRANSGLUTEAL APPROACH FOR IMPLANTATION OF A SHORT STEM TOTAL HIP ARTHROPLASTY -
PROSPECTIVE, RANDOMISED CLINICAL AND GAIT ANALYSIS STUDY
Flörkemeier T, Budde S, Radtke K, Jakubowitz E,
Hurschler C, Seehaus F, Ezechieli M, Windhagen H, von Lewinski G
Introduction/objectives: Over the last years the number of short stem
hip arthroplasty increased due to bone preserving strategies, more physiological
application of force to the proximal femur and a less invasive implantation
technique. Previous studies published data on the influence of different approaches
for standard THA. The aim of this prospective, randomised study was to determine the
outcome after implantation of a short stem arthroplasty.
Methods: In this prospective study 60 patients with progressive
osteoarthritis of the hip were included. Exclusion criteria were age >70, BMI
>35, neurological disease and implantation of a THA or TKA within the last 6
months. The outcome after implantation of the METHA® short stem
arthroplasty (Fa. Aesculap, Tuttlingen) via anterolateral and transgluteal approach
was compared. Direct pre-operative as well as 3, 6 and 12 months postoperatively a
3D gait analysis was conducted determining kinematic parameter as well as kinetic
parameter. Along with that clinical outcome was assessed via Harris Hip Scores.
Results: The clinical results showed no significant difference between
the groups of the anterolateral and transgluteal approach over 12 months
postoperatively. A continuous improvement was observed.
According to the data of the gait analysis the anterolateral approach has a
protective effect on the gluteal muscles compared to the transgluteal approach. All
other parameters did not show a significant difference between both groups of
approaches.
Conclusions: The data showed comparable clinical outcomes after
implantation of a METHA® short stem using both approach. According to the
data of the gait analysis the anterolateral approach has a protective effect on the
gluteal muscles compared to the transgluteal approach.
OP02-183 ASSESSING TISSUE DAMAGE CAUSED BY DIFFERENT SURGICAL APPROACHES IN
TOTAL HIP ARTHROPLASTY USING LEUKOCYTE KINETICS
Rykov K1, Van Den Bossche W2,
Ten Have B1, Knobben B1, Sietsma M1, Van Raay
J1, Van Dongen J2
1Martini Hospital, Groningen, The Netherlands; 2Erasmus Medical
Center, Rotterdam, The Netherlands
Introduction/objectives: Whether there is a difference in tissue damage
between the classical posterolateral and direct anterior approach of the hip joint
is under debate. As leukocytes are precursors to macrophages, known to keep tissue
free of debris, their numbers should change as response to tissue damage. This can
allow an objective assessment of tissue damage. The objective is to investigate
tissue damage caused by the anterior or posterolateral approach for total hip
arthroplasty using peripheral blood leukocytes subset kinetics.
Methods: A prospective cohort study with 55 patients undergoing total
hip arthroplasty by either an anterior or posterolateral approach was performed.
Blood was drawn at 6 time points (pre-operatively, 2 hr, 24 hr, 48 hr and 2 and 6
weeks postoperatively) and flow cytometrically assessed for leukocyte subset numbers
using standardized EuroFlow staining and analysis protocols. A Friedman's test and
the Wilcoxon signed rank test were performed to analyse and identify
differences.
Results: Significant changes were found in the absolute numbers of
leukocyte subsets per time point. All subsets decreased postoperatively and returned
to pre-operative numbers at later time points. There were no differences found in
tissue damage between the approaches concerning the leukocyte subset kinetics.
Leukocytes responded very quickly (<4 hours) to tissue damage.
Conclusions: Although no difference were found between the approaches,
the individual subset kinetics suggest a new diagnosing and monitoring application
for blood leukocyte that might provide a tool to objectively compare tissue damage
caused by a surgical approach.
OP02-145 EFFECT OF SURGICAL APPROACH AND HEAD SIZE ON REVISION RATE AFTER
TOTAL HIP ARTHROPLASTY IN THE NETHERLANDS
Zijlstra W1, De Hartog B1, Van
Steenbergen L2, Schreurs W3, Nelissen
R4
1Department of Orthopaedics, Medical Centre Leeuwarden, Leeuwarden, The
Netherlands; 2Dutch Arthroplasty Register, Landelijke Registratie
Orthopedische Implantaten (LROI), ‘s-Hertogenbosch, The Netherlands;
3Department of Orthopaedics, Radboud University Medical Centre, Nijmegen,
The Netherlands; 4Department of Orthopaedics, Leiden University Medical
Centre, Leiden, The Netherlands
Introduction/objectives: We examined the influence of surgical approach
and femoral head size on revision rate after total hip arthroplasty (THA).
Methods: Data on primary and revision hip arthroplasty are recorded in
the LROI, the nationwide population-based arthroplasty register from the
Netherlands. We selected all 145,316 primary THAs and all 3,494 revision THAs
performed in 2007-2014. Metal-on-metal bearings were excluded. Revision rate for
dislocation and revision rate for all other causes were calculated by competing risk
analysis.
Results: Revisions for dislocation after THA are scarce (1.1% for 22-28
mm heads after 6 years), but more frequent after posterolateral approach in
comparison to anterior and anterolateral approaches (1.0%, resp. 0.4%, 0.5% at 6
years). Most revisions after posterolateral approach are due to dislocation (36%;
stem loosening 18%); the opposite is true for anterior and anterolateral approaches
(31% stem loosening; dislocation 19%). Taking all other reasons for revision into
account, the 6-year risk of revision is highest with the anterior approach (4.2%)
and lowest with the posterolateral approach (1.9%), even after excluding the first
50 anterior approaches. Larger heads (36 mm and 32 mm) reduce dislocation revisions
significantly compared to 22-28 mm heads: 6-year revision rates were 0.4% and 0.7%
respectively compared to 1.1%. However, 36 mm heads increased revisions for other
reasons, compared to 32 and 22-28 mm heads (2.7% versus 2.0%).
Conclusions: Anterolateral and anterior approach reduce the risk of
dislocation revisions, but at the cost of more stem loosening and other revisions,
when compared to the posterolateral approach. Dislocation revision risk can more
easily be reduced by increasing femoral head size from 28 to 32 or 36 mm.
OP02-123 DOES DIRECT ANTERIOR APPROACH WORK IN DIFFICULT PRIMARY THA?
Tehran University of Medical Science, Joint Reconstruction Research Center, Tehran,
Islamic Republic of Iran
Introduction/objectives: Total hip arthroplasty is the treatment of
choice in severe hip joint destruction such as osteoarthritis, congenital hip
disorders, inflammatory disease. In our description, difficult primary cases are
protrusion acetabuli, DJD secondary to perthes disease and other congenital hip
involvement with short neck and large head and greater Trochanter overgrowth, Crow
type III and IV Development dysplasia Hip. Each of these diagnoses are technical
challenges for the surgeon. The purpose of this manuscript is to describe our
experience with total hip Replacement in these challenging cases through direct
anterior approach.
Methods: From Jan 2011 to Dec 2013, 25 hips in 23 patients (15 women and
10 men) were subjected to total hip arthroplasty at the Emam Hospital. The reasons
for THA were 11 protrusio acetabuli secondary to JRA and R.A, 7DDH, 5 short neck and
greater trochanter overgrowth. The average age was 34/5 years. All patients
underwent THR with Direct anterior approach in supine position. Operation time,
complication Rate, Functional outcome were evaluated.
Results: Average operating time was 78 minutes and no longer than
straight forward cases. Dislocation, Infection, DVT did not occur postoperatively.
Medial wall reconstruction was done with chips allograft in 5 protrusio acetabuli. 2
greater trochanter fx and 1 calcar crack occurred intraoperatively and fixed with
wire. No femoral shortening was needed. Postoperatively, Harris score improved 42.5
± 6/3 to 88.3 ± 7.4.
Conclusions: Primary THA in difficult cases is challenging because of
hip flexion contracture and difficult femoral head dislocation. THR in difficult
cases via DAA is possible, easier with shorter operating time and less complication
rate.
OP02-109 COMPARISON OF POSTOPERATIVE RANGE OF MOTION AFTER TOTAL HIP
ARTHROPLASTY USING POSTERIOR, ANTEROLATERAL AND DIRECT ANTERIOR APPROACH: A
SINGLE SURGEON SERIES
1Takatsuki General Hospital, Takatsuki, Japan; 2Kobe University
Graduate School of Medicine, Kobe, Japan
Introduction/objectives: The purposes of this study were to compare
postoperative range of motion (ROM) after total hip arthroplasty (THA) using 3
different approaches (posterior, anterolateral and direct anterior), and to better
define the associations between postoperative hip ROM and surgical approaches.
Methods: The authors measured pre-operative passive hip ROM under
general anesthesia and postoperative hip ROM 1 year after THA in 138 hips (44 hips
with posterior, 62 hips with anterolateral, 32 hips with direct anterior approach).
Hip flexion, abduction, internal rotation in extension (0° of flexion), and external
rotation in extension (0° of flexion) were recorded by the goniometer method. The
ROM change was defined as the absolute value of the difference between the
postoperative ROM and pre-operative ROM.
Results: Postoperative internal rotation motion of THA with posterior
approach (mean 35.1°) was significantly greater than both with direct anterior (mean
18.5°) and anterolateral approach (mean 17.4°). There was no significant difference
in postoperative external rotation motion among three approaches. The change in both
internal and external rotation motion of THA with posterior approach (mean 23.4°)
was significantly greater than both with direct anterior (mean 5.1°) and
anterolateral approach (mean 9.2°).
Conclusions: The hip rotational motion after THA could be affected by
surgical approach. Internal rotation motion with posterior approach could be
significantly greater than other approaches due to damage of posterior soft tissues.
Choice of surgical approach for THA should be based on pre-operative hip ROM and
patient characteristics.
OP03 Mid-and Long-term Results
OP03-279 MID-TERM OUTCOMES OF A CLINICAL AND DENSITOMETRIC PROSPECTIVE STUDY
ON TRABECULAR TITANIUM CUPS
1Orthopaedic Institute of University, Ferrara, Italy;
2Orthopaedic Department, Azienda Ospedaliera Torino, Turin, Italy;
3Radiology Department, Azienda Ospedaliera Cittadella della Salute,
Turin, Italy; 4Orthopaedic Institute of University, Udine, Italy
Introduction/objectives: Osteo-integration of prosthetic hip cups is one
of the main biological goals after total hip replacements. This multicentre
prospective study aimed to evaluate periacetabular osseointegration and bone
remodelling around Trabecular Titanium cups via DEXA.
Methods: 89 patients (91 hips) underwent primary THA between 2009-2010;
they were 48% women, with a median (IQR) age and BMI of 67 (57-70) years and 26
(24-29) kg/m2. Radiographic and clinical evaluation (HHS, SF-36) were
performed pre-operatively and at 7 days, 3, 6, 12, 24, 60 months (mo.). Bone Mineral
Density (BMD g/cm2) was determined by DEXA using DeLee/Charnley 3
ROIs.
Results: BMD initially decline from baseline at 7 days (median [IQR] ROI
I: 1.44 [1.22-1.67]; ROI II: 1.23 [0.99-1.49]; ROI III: 1.11 [0.87-1.48]) to 6 mo.
(ROI I: 1.27 [1.09-1.52]; ROI II: 1.14 [0.89-1.37]; ROI III: 1.05 [0.74-1.35]).
Then, BMD slightly increased or stabilized in all ROIs up to 24 mo. (ROI I: 1.30
[1.11-1.54]; ROI II: 1.12 [0.96-1.35]; ROI III: 1.04 [0.81-1.24]), while showing
evidence of declining over time with increasing patient' age at 60 mo, although
without any clinical significance in terms of patients health status or implant
stability. Median (IQR) HHS and SF-36 improved from 48 (39-61) and 49 (37-62)
pre-operatively to 99 (96-100) and 76 (60-85) at 60 mo. X-rays showed evident signs
of osseointegration, with presence of supero-lateral and infero-medial bone
buttress, and radial trabeculae in ROI I/II. No RLs were observed. All cups resulted
stable without any revision or failure at 60 mo.
Conclusions: Evaluation of BMD and X-rays confirmed good implant
stability and effective osseointegration at 60 mo. All patients reported significant
improvements in quality of life, pain relief and functional recovery.
OP03-248 MIDTERM OUTCOMES OF TOTAL HIP REPLACEMENT USING A DELTA-ON-DELTA
ARTICULATION
Fitch D
MicroPort Orthopedics Inc., Arlington, USA
Introduction/objectives: Ceramic-on-ceramic articulations in total hip
replacement (THR) have become increasingly popular in younger patients. The
objective of the current study was to evaluate the midterm outcomes of a
BIOLOX® delta-on-delta ceramic articulation used in combination with
PROCOTYL® L acetabular components (MicroPort Orthopedics Inc.,
Arlington, TN, USA).
Methods: The National Joint Registry of England, Wales, Northern
Ireland, and Isle of Man (NJR) was independently searched for patients implanted
with the specified components on June 5, 2015. Survivorship for all THRs was
calculated using Kaplan-Meier analysis and all patients with at least 5 years
follow-up were sent Oxford Hip and EQ-5D Scores to complete. All THRs were included
regardless of femoral component or indications for implantation.
Results: There were 2,397 THRs implanted with the specified components
with a cumulative survivorship of 97.6% (95% CI, 96.1-98.3) at 6 years with revision
of any component for any reason as the endpoint. Reasons for revision included
infection (0.5%), pain (0.3%), periprosthetic fracture (0.3%), aseptic loosening
(0.2%), dislocation (0.2%), component malalignment (0.1%), implant fracture (0.1%),
and other/not specified (0.1%). Mean Oxford Hip and EQ-5D scores at final follow-up
were 39.6 (95% CI, 38.2-40.9) and 0.8 (95% CI, 0.7-0.8), respectively.
Conclusions: Survivorship of the PROCOTYL® L acetabular
component with a delta-on-delta articulation compared favorably to the survivorship
at 6 years (97.5%) for all cementless cups in the NJR excluding metal-on-metal
articulations. These results suggest satisfactory survivorship and functional
outcomes similar to other THR systems.
OP03-211 MIDTERM RESULTS OF RECAP/MAGNUM/TAPERLOCK METAL ON METAL TOTAL HIP
ARTHROPLASTY WITH MEAN FOLLOW-UP OF 7.1 YEARS
Koutalos A1, Scholes S2, Joyce
P2, Kourtis A1, Smith E1
1Avon Orthopaedic Center, Southmead Hospital, Bristol, UK;
2School of Mechanical and Systems Engineering, Newcastle, USA
Introduction/objectives: All metal on metal (MoM) devices are the
subject of continuing surveillance. This study reviewed the midterm results of the
ReCap/Magnum total hip replacement (THR) combination along with retrieval analysis
of failed implants.
Methods: A retrospective review of 79 ReCap/Magnum/TaperLoc THR with a
mean follow-up 7.1 years (range 3.7-9.2) was performed. The cohort included 43
females and 36 males. Metal ions were measured and postoperative radiographs were
taken. ‘Margin of safety’ (MOS) angles were measured on radiographs to quantify the
risk of edge loading. At follow-up, when there was a clinical suspicion of adverse
reaction to metal debris, patients had MARS MRI. Asymptomatic patients whose device
had been in situ for 5 years were also offered MARS MRI. Function was evaluated with
Harris Hip Score (HHS), Oxford Hip Score (OHS), SF-12 and EQ-5L-5D. Wear from the
articulating surfaces of five of seven revised ReCap/Magnum THR was measured on a
coordinate measuring machine (CMM).
Results: Seven hips had been revised, indicating 91.1% survivorship at
7.1 years. Postoperative HHS and OHS significantly improved. Females and symptomatic
patients predicted increased metal ions. MOS correlated with postoperative OHS. 40%
of hips evaluated by MARS MRI were found to have positive results. The rate of
positive MARS MRI in the asymptomatic group was 41%. Wear analysis on the retrieved
THR implants showed the mean volumetric wear rate to be 6.1 mm3/year,
with a range of 4.1-7.6 mm3/year. The mean femoral head/acetabular cup
wear ratio was 62: 38 (range 54: 46-69: 31). The femoral head wear volume was larger
than the wear on the acetabular cup in all retrieved implants.
Conclusions: The overall revision rate in this study cohort was found to
be satisfactory. However, although the ReCap has a favourable arc of cover, when
considering the adverse MARS MRI statistic in combination with wear rates of the
retrieved implants, this indicates that further failures may occur.
OP03-65 OUTCOME OF A HEMISPHERICAL POROUS-COATED ACETABULAR CUP WITH
PROXIMALLY HYDROXYAPATITE-COATED ANATOMIC STEM. A CONCISE FOLLOW-UP REPORT AT A
MEAN OF TWENTY YEARS
Carbonell Escobar R, Garcia-Rey E, Garcia-Cimbrelo
E
Hospital Universitario La Paz, Madrid, Spain
Introduction/objectives: Durable bone fixation of uncemented
porous-coated acetabular cups can be observed at ten to fifteen years of follow-up,
however, polyethylene wear and osteolysis may affect survivorship at a longer
follow-up.
We report the updated results at twenty years for a previously described cohort of
patients who underwent a single uncemented total hip replacement.
Methods: The original series consisted of 111 hips evaluated at a mean
of 13.4 years, 82 were available at a mean follow-up of 19.6 years (range, 18 to
21). A Duraloc acetabular component matched to a Profile hydroxyapatite-coated
anatomic stem and a 28 mm PE liner, sterilised by gamma irradiation in air, was used
in all hips. The mean age at surgery was 56.8 (±10.9) and there were 44 women.
Radiological postoperative position and the possible appearance of loosening was
recorded in all hips. Kaplan-Meier survivorship analysis with 95% confidence
interval (CIs), was used to estimate the cumulative probabilities of not having
revision surgery.
Results: 11 cups were revised: 6 due to wear and 5 due to late
dislocation. The probability of not having revision surgery for any cause at 15
years was 91.1 ± 7.0 and 65.3 ± 26 at 20 years. All cups were radiographically
well-fixed and all stems showed radiographic ingrowth. Regression analysis showed
that none of the demographic or radiological data had a higher risk for revision
including patient age above 55 years old (p = 0.35), an abducted cup higher than 50°
(p = 0.749) or a distance to the rotation hip centre according to Ranawat of 4 mm or
more (p = 0.52).
Conclusions: Continued durable fixation can be observed with uncemented
porous-coated cups in primary THR at a very long-term. Polyethylene wear and late
dislocation were the main reasons for revision surgery after twenty years.
OP03-323 CLINICAL AND RADIOGRAPHIC OUTCOMES AT 25 TO 30 YEARS OF 347 THAs WITH
HA-COATED STEMS
Jacquot L, Rollier JC, Chouteau J, Machenaud A,
Vidalain JP
Centre Hospitalier Annecy Genevois, Metz Tessy, France
Introduction/objectives: The concept of total osteointegration of a
tapered stem was introduced three decades ago to achieve durable biologic fixation
while preserving normal periprosthetic bone trophicity. While numerous studies
reported successful long-term outcomes of THA with bioactive fixation, little is
known about the survival and fixation of these implants beyond the first 25
years.
Methods: The authors evaluated clinical and radiographic outcomes, at a
follow-up of 25 to 30 years, of a series of 347 THAs (320 patients) aged 64.3 ± 11.3
years. The patients were operated by a single surgeon (AM) between 1986 to 1990
using the Corail stem (DePuy, Leeds, UK). Of the initial 347 hips, 224 (64.6%) were
in deceased patients, 29 (8.4%) were lost to follow-up, 52 (15.0%) had acetabular
component revision, 13 (4.0%) had polyethylene insert revision, and 12 (3.8%) had
femoral stem revision.
Results: The remaining cohort of 82 THAs (69 patients) were assessed at
26.8 ± 1.2 years (range, 25.1-29.4). The Kaplan-Meier survival was 93.9% (CI,
90.5-97.5) considering revision of the stem as endpoint, and was 62.5% (CI,
55.6-70.3) considering revision of any component as endpoint. Despite the incidence
of acetabular osteolysis due to wear of polyethylene inserts, the femoral fixation
was seldom affected beyond the proximal calcar region. Periprosthetic bone
remodelling was limited, and in most cases proved natural, by comparison to the
intact contralateral hip. Comparison of serial radiographs revealed great stability
of stem fixation beyond 20 postoperative years with no signs of radiolucency,
migration nor pedestal formation.
Conclusions: This historical exceptional study demonstrates very long
term reliability of the full HA coated cementless option in Total Hip
Arthroplasty.
OP03-194 LONG-TERM RESULTS OF TOTAL HIP ARTHROPLASTY FOR THE TREATMENT OF
ANKYLOSED HIPS
Introduction/objectives: The purpose of this study was to report the
long-term results of total hip arthroplasty of ankylosed hip. The factors that were
likely to influence the functional outcome were analysed.
Methods: 32 consecutive total hip arthroplasties were performed in 29
patients. The mean age of the patients at the time of the operation was 44.2 years
(range, 19 to 79 years). Ankylosis of the hip had been spontaneous in 13 and
postoperative in 19 patients. The mean duration of the ankylosis had been 20.2 years
(range, 4.2-55). We used cementless fixation in 28 hips and cemented fixation in 4
hips. The mean duration of follow-up was 10.4 years (range, 4.5-26). Survivorship
analysis was conducted using the Kaplan-Meier method using second revision for any
reason as the endpoint.
Results: The mean hip score, according to the Harris hip scale, was 85.6
(range; 55 to 98) points. Twenty-four percent of patients need to use one support
for walking and fourteen hips showed positive trendelenburg sign after surgery. We
observed abductor muscle problems (gluteus medius distal avulsion in five, gluteus
medius proksimal avulsion in one, trochanter major avulsion in 2) in 25% of all
cohorts during surgery. One acetabulum fracture and one femur fracture were seen
intraoperatively. Heterotopic ossification were seen type one in 2 patients, type
three in 3 patients and type 3 in 2 patients according to Brooker classification.
The cumulative survival rate at ten, with aseptic revisions as the end point, was
97.5% (95% confidence interval, 79.75% to 100%).
Conclusions: Status of the gluteal muscles should be evaluated in
ankylosed hips when total hip arthroplasty is being considered. Cementless fixation
showed good to excellent results at ten years.
OP03-233 LONG-TERM RESULTS OF PRIMARY HIP ARTHROPLASTY AT A MEAN OF 20 YEARS
OF FOLLOW-UP IN PATIENTS WITH HIP DYSPLASIA
Colo E, Rijnen WHC, Gardeniers JWM, van Kampen A,
Schreurs BW
Radboudumc, Nijmegen, The Netherlands
Introduction/objectives: Developmental dysplasia of the hip (DDH) is a
common cause of secondary osteoarthritis (OA) in younger patients and when end-stage
OA develops, total hip arthroplasty (THA) is inevitable. Different options have been
developed to reconstruct the acetabular defects in this patient group. In our
institution we prefer to restore the bone defects with the use of impaction bone
grafting (IBG) combined with a cemented cup. We evaluated the long-term survival at
a minimum follow-up of 15 years, the radiographic appearance of the bone graft and
radiographic signs of implant loosening.
Methods: We retrospectively reviewed 22 patients (28 hips) with
secondary OA due to DDH. No patients were lost for review. Four patients died before
15 years of follow-up, but their data were included. The minimum follow-up was 15
years (mean 20.4 years, 16-29 years). In all cases the acetabular defects were
combined cavitary and segmental.
Results: The Kaplan-Meier survival at both 15 and 20 years, with
endpoint revision for any reason was 92.4% (95% CI 73-98), whereas this was 95.8%
(95% CI 74-99) with endpoint revision of the cup for aseptic loosening. Three
revision surgeries were performed. Two cup revisions were performed for aseptic
loosening at 12.3 and 26.2 years. Another cup revision was performed due to a
sciatic nerve palsy at 2.3 years. None of the unrevised cups showed migration or
radiographic failure.
Conclusions: Cemented primary THA with the use of impaction bone
grafting provides a biological solution for acetabular defects and shows satisfying
long-term results in patients with previous DDH.
OP03-264 MID- TO LONG-TERM OUTCOMES OF A MODULAR FEMORAL STEM IN TOTAL HIP
ARTHROPLASTY
Fitch D
MicroPort Orthopedics Inc., Arlington, USA
Introduction/objectives: Modularity in total hip arthroplasty (THA) has
become an increasingly discussed topic in recent years. Published results suggest
outcomes are highly design and material dependent. The objective of the current
study was to evaluate the mid- to long-term outcomes of the modular
PROFEMUR® L femoral stem (MicroPort Orthopedics Inc., Arlington, TN,
USA).
Methods: The database for the National Joint Registry of England (NJR)
was independently searched for patients implanted with the subject stem and any
articulation couple other than metal-on-metal. Survivorship was calculated using
Kaplan-Meier analysis and all patients with at least 5 years follow-up were sent
standard NJR patient reported outcome forms. Patient reported outcomes were
presented as means and 95% confidence intervals.
Results: Between February 2004 and March 2015, there were 3,363 THAs
performed with the subject stem. The survivorship was 97.2% and 95.4% at 5 and 9
years, respectively, with revision for any reason as the endpoint. At final
follow-up mean Oxford Hip and EQ-5D scores were 39.1 (95% CI, 38.2-39.9) and 0.77
(95% CI, 0.75-0.79), respectively.
Conclusions: This study is the first to report outcomes for the subject
stem. Survivorship was not statistically different than that reported for all other
cementless stems in the NJR at both 5 years (97.6%) and 9 years (96.2%). Functional
outcomes were also similar to those that have been reported for other THA
devices.
OP04 THA
OP04-365 POSTSURGICAL NERVE LESION, NOT ONLY SURGEON RESPONSIBILITY: HNPP A
RARE CAUSE OF NERVE LIABILITY
Donati F, De ieso C, Del Tedesco F, Cambise C, Coraci D, Padua L,
Logroscino G
Fondazione Gemelli U.C.S.C., Rome, Italy
Introduction/objectives: Hereditary neuropathy with liability to
pressure palsies (HNPP) is an autosomal dominant hereditary demyelinating neuropathy
caused by micro-deletion of PMP22 gene locates on the 17p11.2. The abnormal myelin
in HNPP increases susceptibility to peripheral nerve damages by nerve
compressions.
Methods: A 66 year-old male with a story of multiple hip surgeries,
showed a right external popliteal nerve palsy without any evident reasons, after a
total hip arthroplasty revision procedure through a postero-lateral approach. No
peripheral nerve block anaesthesia was performed peri- or post-operatively.
Electrophysiological tests (EMG) and nerve ultrasounds (US) were performed.
Results: EMG showed absence of motor and sensory response of fibular
nerve and diffuse slow conduction velocities associated with low action potential in
other nerves of upper and lower limbs bilaterally, typical of a demyelinating
neuropathy. Nerve US showed a bilateral marked enlargement of fibular nerve at
fibular head and of median and ulnar nerves at wrist and elbow level respectively.
Suspecting HNPP, genetic tests were requested confirming the 17p11.2 microdeletion.
At 2 years follow-up the patient is completely autonomous and able to walk with a
cast.
Conclusions: Demyelinating neuropathies such as HNPP need to be
investigated before surgery to plan appropriately the operation and to inform the
patient about the possible risks. Clinical history assessment, focused on familiar
and personal neurological elements, as past transient sensorimotor deficit related
to posture could allow to screen patients needing further investigations. The
diagnosis of a latent neuropathy, which can occur after surgical intervention, may
avoid the wrong attribution to surgical malpractice.
OP04-73 RELATIONSHIP BETWEEN THE PAIN OF HIP OSTEOARTHRITIS AND INTENSITY
CHANGE OF THE FEMORAL HEAD ON MAGNETIC RESONANCE IMAGING OR ATROPHY OF PSOAS
MAJOR MUSCLE
1Department of Orthopaedic Surgery, Akita University, Akita city, Japan;
2Akita Hip Research Group, Akita city, Japan
Introduction/objectives: In hip osteoarthritis, the degree of pain can
vary despite similar imaging findings. Intensity change of the femoral head on
magnetic resonance imaging (MRI) and atrophy of the psoas major muscle were
investigated as candidate factors associated with the pain of hip
osteoarthritis.
Methods: Forty-six hip joints (23 consecutive pre-operative
osteoarthritis hips, 23 normal contralateral hips) were examined. At first, on
coronal T2-weighted fat-suppressed MRI, intensity of the femoral head was quantified
in the slice on which size of the femoral head was maximal. Next, cross-sectional
area of the psoas major muscle was measured at the level of the iliac crest on
computed tomography. We evaluated the relationship between pre-operative pain and
the ratios of these indices (femoral head intensity and psoas major muscle volume)
for the osteoarthritis side compared to the contralateral normal side.
Results: Mean visual analogue scale score for pre-operative pain was
79.3 ± 19 mm. Mean ratio of femoral head intensity on MRI was 1.97 (range,
1.00-3.88). Mean ratio of psoas major muscle volume was 0.67 (0.34-0.92). The ratio
of psoas major muscle volume and visual analogue scale showed a negative correlation
(r = −0.5746, P = 0.0251) when cases with a ratio of femoral head intensity >2.0
were excluded.
Conclusions: When cases with strong intensity change of the femoral head
on MRI were removed, a smaller volume of psoas major muscle was associated with
stronger pain. When cases with pain derived from bone were removed, instability due
to amyotrophy may contribute to the pain of osteoarthritis. Muscle training may thus
improve hip joint stability and help to reduce pain.
OP04-14 HOW IMPORTANT IS BONE MINERAL DENSITY IN HIP ARTHROPLASTY?
Maier G, Kolbow K, Lazovic D, Maus U
University of Oldenburg, Oldenburg, Germany
Introduction/objectives: In patients scheduled to undergo joint
arthroplasty, the bone quality around the joint affects the safety of prosthetic
implantation and furthermore the satisfaction with the postoperative outcome. Bone
strength is clinically assessed by measuring bone mineral density using dual-energy
X-ray absorptiometry, therefore we asked if bone mineral density is of any
importance to orthopaedic surgeons performing hip arthroplasty.
Methods: A 14-question survey was administered to orthopaedic surgeons
who are performing hip arthroplasty on a regular level. Orthopaedic surgeons were
asked about treatment patterns with respect to bone mineral density, osteoporosis
work up and treatment for patients with low bone mineral density scheduled to
undergo hip arthroplasty.
Results: 433 completed questionnaires were available for analyses. 72%
of all asked orthopaedic surgeons reported to use cementless implants as a standard
in hip arthroplasty. A known osteoporosis influences 54% of the surgeons in their
decision making process. Over 60% reported that low bone mineral density is a reason
to reconsider treatment and operation strategies, but only 4% performed bone mineral
density measurement on a regular base pre-operatively. 24% would change their
treatment strategy in case of a bone mineral density (T-Score) between −1.5 and −2,
40% in case of a T-score between −2 and −2.5, and 29% would change their intraop
strategy if a T-score smaller −2.5 was measured. 93% of all asked orthopaedics would
change from cementless to cemented implants.
Conclusions: Due to the demographic change orthopaedic surgeons will be
faced regularly with osteoporosis while performing arthroplasty, resulting in an
increasing need for awareness regarding bone mineral density and osteoporosis.
OP04-135 TERIPARATIDE SEEMS TO IMPROVE RECOVERY AFTER PERTROCHANTERIC HIP
FRACTURE: COMPARISON WITH RISEDRONATE IN A RANDOMIZED, CONTROLLED TRIAL
1Department of Clinical and Experimental Medicine, Linköping University,
Linköping, Sweden; 2Department of Orthopaedic Surgery, University Tor
Vergata, Rome, Italy; 3Department of Biomedical Surgical and Dental
Sciences, University of Milan, Division of Orthopaedy and Traumatology, Milan,
Italy; 4Department of Orthopaedic Surgery and Traumatology, Odense
University Hospital Institute of Clinical Research, Odense C, Denmark;
5Orthopaedic Surgery, Aarhus University Hospital, Aarhus C, Denmark;
6Department of Orthopaedic Surgery, Oslo University Hospital, Oslo,
Norway; 73rd Orthopaedic Department, Aristotle University of
Thessaloniki, Papageorgiou General Hospital, Thessaloniki, Greece;
8Department of Internal Medicine, Hospital San Pablo, Barcelona, Spain;
9Osteoporosis Center, University Hospital, Monterrey, Mexico;
10Eli Lilly Research Centre Ltd, Windlesham, UK
Introduction/objectives: To compare the effects on fracture recovery of
26 wks' therapy with an oral antiresorptive (risedronate: RIS 35 mg QW) or a bone
forming drug (teriparatide: TPTD 20 ug QD) started within 2 wks after osteosynthesis
in a pertrochanteric hip fracture in patients with low bone mass.
Methods: 224 patients were randomized to study drug and an
oral/injectable placebo plus calcium/vitD3 in an osteoporosis trial. The primary
outcome was bone mineral density which will be reported elsewhere. We report
secondary (Timed Up-and-Go [TUG] test, hip pain, SF-36, safety) and exploratory
(radiography) endpoints. Efficacy analyses of the TUG test, patient-rated health
status, and hip pain 100 mm Visual Analog Scale were performed with a Mixed-effects
Model for Repeated Measures.
Results: Mean age was 77 years and 77% were female. The teriparatide
group completed the TUG test in a shorter time (LS means 5.7, 4.4, 3.1, and 3.1
seconds less at 6, 12, 18, and 24 wks; overall difference p = 0.021) and reported
less hip pain during the test (LS means 8.7, 10.6, 11.9, and 10.2 mm differences at
6, 12, 18, and 26 wks; overall difference p = 0.032). No significant between-group
differences in SF-36, Charnley hip pain score, ability to walk or walking aids
during follow-up. No patient was radiographically healed at 6 wks, and 90% were
healed at 12 wks in both groups. Implant failure (TPTD:7, RIS:8), loss of reduction
(TPTD:2, RIS:4) or non-union (0 cases) showed no significant differences. Mild
hypercalcemia and hyperuricemia were more frequent with teriparatide.
Conclusions: Patients treated with teriparatide reported less hip pain
and shorter time to complete the TUG test than RIS between 6-26 wks. These outcomes
were secondary.
OP04-87 CEMENTLESS ONE-STAGE BILATERAL TOTAL HIP ARTHROPLASTY IN
OSTEOARTHRITIS PATIENTS: FUNCTIONAL OUTCOMES AND COMPLICATIONS
Taheriazam A1, Saeidinia A2,
Safdari F3
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Guilan University of Medical Sciences, Rasht, Islamic
Republic of Iran; 3Bone, Joint and Related Tissues Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Total hip arthroplasty (THA) is one of the
successful and cost-benefit surgical treatments. One-stage bilateral THA (BTHA) has
a large number of advantages. While, there are concerns about the higher
complications in this procedure. Aim of our study was to evaluate the complications
and outcomes of cementless one-stage BTHA in osteoarthritis patients.
Methods: A total of 147 patients from 2009 till 2013, were underwent
one-stage bilateral total hip arthroplasty (BTHA) in Milad and Erfan hospitals,
Tehran, Iran. A prospective analysis of the functional outcomes and complications of
one-stage BTHA through Hardinge approach in patients with osteoarthritis performed.
We evaluated all patients clinically and radiologically with serial follow-ups. A
clinical hip score based upon the modified Harris Hip Score (MHHS) was performed
pre-operatively and again postoperatively.
Results: During period of study 89 men (60.5%) and 58 women (39.4%) with
a mean age of 54.67 ± 7.08 years at the time of presentation were recruited. The
mean surgical time was 2.8 ± 0.25 hrs. The mean hospital stay was 3.83 ± 0.65 days.
Hemoglobin level decreased significantly after operation (P = 0.038). There was two
deep venous thrombosis, one superficial infection and one temporal proneal palsy but
no pulmonary embolism, dislocation, periprosthetic fracture or heterotrophic
ossification. The mean pre-operative MHHS score was 41.64 ± 5.42 in patients. MHHS
score improved to 89.26 ± 4.68 in the last follow-up (P = 0.0001).
Conclusions: Our results recommend the use of cementless one-stage BTHA
through Hardinge approach in patients with bilateral hip osteoarthritis.
OP04-166 HIP ARTHROPLASTY IN PATIENTS WITH COMPLEX FEMORAL DEFORMITY AFTER
SURGICAL TREATMENT OF DYSPLASIA
Tikhilov R, Shubnyakov I, Denisov A, Bliznyukov
V
Vreden Russian Institute of Traumatology and Orthopaedics, Saint Petersburg, Russian
Federation
Introduction/objectives: Patients with complex femoral deformity,
including all deformities of the femur below lesser trochanter are serious problem
of THA.
Analysis of mid-term results of total hip arthroplasty in patients with complex
deformities of the femur comparing with standard cases of primary THA and identify
the factors influencing functional outcomes.
Methods: In Vreden Institute 73 patients with complex deformities of the
femur underwent THA between 2001 and 2013 in different options: arthroplasty without
femoral osteotomy (23); arthroplasty accompanied by great trochanteric slide
osteotomy or Paavilainen technigue (37), arthroplasty with femoral osteotomy below
the lesser trochanter (13), including 4 - at the level of deformation, 4 - with
double two-stage osteotomy and 5 - with one-stage double osteotomy. All patients
were assessed using Harris Hip Score before and after surgery. The results obtained
in this study were processed using statistical methods, including correlation
analysis.
Results: Harris hip score in mean follow-up 6.9 years (from 2 to 14
years) improved from 40.2 (95% CI 38.2 to 45.6) pre-operatively up to 78.4 (95% CI
76.7 to 83.5). The analysis of various factors influencing the results showed that
the most significant ones were pre-operative hip function and a low level of pain
(Harris Hip Score 40-45 points), residual femoral deformation more than 5 degrees,
the rotation centre displacement - more than 30 mm, the offset increasing - more
than 20 mm and of limb length increasing - more than 30 mm.
Conclusions: Hip arthroplasty in patients with hip arthritis associated
with complex femoral deformities is technically challenging, but using of the
algorithm presented by authors allows to achieve the better results.
OP04-119 MEDIUM TERM OUTCOME OF CEMENTLESS TOTAL HIP ARTHROPLASTY IN PATIENTS
WITH JUVENILE RHEUMATOID ARTHRITIS
Aminjavaheri S, Mortazavi SMJ, Mostafavi Tabatabaee
R
Tehran University of Medical Science, Joint Reconstruction Research Center, Tehran,
Islamic Republic of Iran
Introduction/objectives: Juvenile Rheumatoid arthritis (JRA) is the most
common type of arthritis in children usually affecting hips severely. Most surgeons
rarely recommend total hip arthroplasty (THA) to this group because of potentially
high failure rate. This study aimed to evaluate outcomes of modern design uncemented
THA via anterior approach in JRA patients with bilateral hip involvement. Using our
institutional database.
Methods: We retrospectively identified 11 JRA patients with bilateral
sever hip involvement undergone bilateral THA via direct anterior approach from
January 2010 to January 2012 with minimum follow-up of at least 3 years.
Results: There was a functional improvement at the latest follow up in
all patients (Mean pre-operative Harris Hip score was 49.6 points, improved to 79.7
points at latest follow-up) (p<0.001).
Conclusions: The current report confirms that concurrent bilateral
uncemented THA with a modern generation tapered femoral stem through direct anterior
approach is a reliable procedure in patients with JRA.
OP04-394 CLINICAL OUTCOME OF DUAL MOBILITY CUP IN TOTAL HIP REPLACEMENT FOR
ACUTE FEMORAL NECK FRACTURES
Shah N, Anathallee Y, Tariq A, Jong G, Ng A, Bhamra M, Baskaran
D
MidYorks NHS Trust, Pinderfields General Hospital, Wakefield, UK
Introduction/objectives: The use of primary total hip replacement (THR)
is recommended by National Institute for Health and Clinical Excellence (NICE) for
patients with displaced intracapsular femoral neck fractures who are able to walk
independently with no more than one stick, no cognitive impairment and medically fit
for surgery. The major drawback of THR is a high dislocation rate of 10-22%.
Objective: To evaluate functional outcome in consecutive patients with
Dual Mobility (DM) cup THR following acute femoral neck fractures.
Methods: A retrospective analysis of clinical and radiological records
of patients including SF36, Oxford Hip Score (OHS) and complications.
Results: Between the years 2012 to 2015, 51 patients (female: male = 39:
12) with mean age 73 years (SD, 9.3) (range: 44 to 93) were identified. Mean
follow-up was 23 months (SD, 9.8). Mean final follow-up OHS was 42 (SD, 5.3). Mean
SF-36 physical component was 63 (SD, 26.1) and mean SF-36 mental component was 82
(SD, 19.9). Mean abduction angle was 46.7 degree (SD, 6.63). Mean anteversion angle
was 16.7 degree (SD, 8.17) and mean limb length discrepancy was 5.68 mm (SD, 4.6).
The 30-day mortality was 0%. There were 5 deaths in the series. Three complications
(3 patients: DVT, postoperative haematoma, stitch abscess) were managed successfully
without revision of the prosthesis. There was 1 (2%) revision surgery for
dislocation.
Conclusions: Good functional outcome and quality of life with low
dislocation rate were observed in this cohort of patients. We believe that the
unique cup design may lead to better clinical outcome in THR for acute femoral neck
fractures.
OP04-215 HOW MUCH EVIDENCE IS THERE TO VALIDATE THE TOTAL HIP PROSTHESES
IMPLANTED IN CATALONIA ACCORDING TO THE CATALAN ARTHROPLASTY REGISTRY
(RACat)?
Pons M, Chaverri D, Lobo L
Servei de Cirurgia Ortopèdica, Hospital Sant Rafael, Barcelona, Spain
Introduction/objectives: Arthroplasty registries can perform a critical
role in improving the outcomes of joint replacements and provide unique
community-based comparative data.
The aim of our study is to analyse the evidence supporting the primary total hip
arthroplasties implanted in Catalonia in recent years, based on the Registre
d'Artroplasties de Catalunya (RACat).
Methods: We researched the literature about the stems and cups implanted
in public hospitals in Catalonia between 2005 and 2013, according to the RACat, in
the following databases: the ODEP (The Orthopaedic Data Evaluation Panel),
Tripdatabase, Pubmed and Academic Google. We excluded stems and cups implanted in
quantities of fewer than 10 units (182 cups and 228 stems corresponding to 49 and 63
different models, respectively).
Results: There were 18816 implanted cups listed in the registry and we
analysed 18634 (99%), corresponding to 74 different models. There were 19595 stems,
of which we analysed 19367 (98.84%) corresponding to 75 models. In 19 different cup
models (2551 cups) and in 16 different stem models (1845 stems) we could not find
any clinical evidence that supported their use. In the remaining models, the
evidence differed according to the number of patients and the follow-up, with a
predominance of studies with evidence level IV.
Conclusions: Our study shows that a considerable number of the hip
prostheses implanted in Catalonia have no available evidence of clinical
effectiveness to support their use (13.7% of cups and 9.5% of stems). There is a
considerable number of models (49/123 cups and 63/138 stems) implanted in fewer than
10 units, corresponding to only 1% of the total number of hip arthroplasties.
Registries permit us to analyse our results and reach conclusions such as the ones
shown in this study.
OP05 Paediatrics
OP05-301 THE EVALUATION OF EARLY RESULTS OF USING TOTAL HIP REPLACEMENT IN
TREATMENT OF PAINFUL HIP DISLOCATION IN YOUNG ADULTS WITH SPASTIC PLEGIA
Sionek A, Czubak J, Czwojdzinski A, Grochowski
K
Department of Orthopaedic, Paediatric Orthopaedic CMKP, Warsaw, Poland
Introduction/objectives: Using total hip replacement (THR) in treatment
of painful hip dislocation in patients with spastic plegia reduces pain, enables
early mobilization of patients, but carries a risk of many complications. Only
several years ago spasticity was a contraindication to THR.
Methods: In years 2013-2015 we operated 7 hip-joints of 7 spastic
patients with hip dislocation with spasticity I° i II° according to Ashworth's
classification. In the examined group there were 5 patients with cerebral palsy (CP)
and 2 patients with plegia coming as a consequence of past brain injury.
Results: Mean age of the patients examined was 35 years old (from 17 to
42 years old). Before the operation, the patients led a sedentary or recumbent
lifestyle. Three patients were treated using MDM shells and Accolade stems, the rest
with Wagner's cone stems and Varial shells. Pain was measured using the VAS
scale.
Intraoperative difficulties with repositioning the implanted endoprothesis were
observed in 3 patients, one patient had a fracture of trochanter major, which was
sealed with cerclage. The period of rehabilitation was also longer. In all patients
there was a decrease in pain assessed according to VAS scale. Five patients can walk
with the crutches or a walking frame. No hip luxation or endoprothesis loosening was
observed in the examined group.
Conclusions: It seems to us, that painful hip dislocation in patients
with small degree spastic plegia should be treated using THR.
OP05-163 PRE-OPERATIVE PLANNING FEATURES OF TOTAL HIP ARTHROPLASTY IN PATIENTS
WITH DDH
Shubnyakov I, Tikhilov R, Boyarov A
Vreden Russian Institute of Traumatology and Orthopaedics, Saint Petersburg, Russian
Federation
Introduction/objectives: Careful pre-operative planning is necessary not
only to determine the size of the implant, but the references required for the
correct installation of the components of the prosthesis during surgery. Adequate
pre-operative planning allows to correct leg length alignment. The aim of this study
to improve the methods of pre-operative planning of total hip arthroplasty in
patients with DDH.
Methods: In this study long film X-Rays of 142 patients were evaluated.
Main group included 69 patients with DDH - 37 patients with low hip dislocation
(Hartofilakidis type B), 21 patients with unilateral high hip dislocation (type C),
and 11 patients with bilateral high hip dislocation (type C). In control group 73
patients without hip pathology.
Results: The measurements results showed that in the group with
unilateral high hip dislocation the average difference of absolute lower limb length
was 16.9 mm (from 0 to 54.6 mm), and in the other two groups the average difference
of absolute lengths of the lower extremities was 11.1 mm. Evaluating the
measurements of individual segments of lower extremities indicators average gap
length shanks in all groups of approximately equal, despite the fact that the
difference in the first subgroup tibia length discrepancy reaches 20.4 mm, and
almost 11% greater than 10 mm. Evaluation of measurements of the femur lengths
showed that in the group with unilateral dislocation of the femoral head the average
difference reaches 14.6 mm, in 52.3% higher than 10 mm with a maximum of 54 mm.
Conclusions: This study confirmed the importance of detailed
pre-operative planning of total hip arthroplasty in patients with high dislocation
of the femoral head.
OP05-334 ASSESSMENT OF FEMOROACETABULAR IMPINGEMENT USING MOTION CAPTURE AND
MRI
1Universitätsklinikum Essen, Klinik für Orthopädie und Unfallchirurgie,
Essen, Germany; 2Lehrstuhl Mechanik/Robotik, Universität Duisburg-Essen,
Duisburg, Germany; 3Institut für Radiologie, Universitätsklinik Essen,
Essen, Germany
Introduction/objectives: The presence and extent of femoroacetabular
impingement (FAI) due to bone deformities at the femoral head (cam deformity) are
evaluated by physical and radiological examination. Interpretation of the alpha
angle and other radiological measurements used in MRI assessment is sometimes
difficult as there are varying limit values and high inter-observer variety.
Furthermore, the extent of osteoplasty required to correct cam deformity is not
always obvious. This paper presents a novel approach for the evaluation of FAI using
motion capture and MRI.
Methods: Standard physical examination was performed on ten subjects
with symptomatic cam type FAI in the supine position. The movement of the subjects'
lower body was recorded using marker-based motion tracking. Kinematic evaluation of
the lower body movements was carried out by computer analysis. 1.5 Tesla-MRIs with a
comprehensive thin layer protocol were performed after motion capturing. Using
segmentation software, the pelvis and femur were segmented from the MRIs and
integrated into the respective capturing analysis. Finally, hip motion and impact of
the femur against the acetabular rim were simulated using a Finite Element Method
solver.
Results: Simulations provided a good representation of the motion of the
femur in relation to the pelvis showing that narrowing of the joint space was
accompanied simultaneously by patients reporting the occurrence of pain.
Conclusions: Simulation based on motion capture and MRI is a feasible
method for evaluation of FAI, which is based on the patient's individual range of
motion. As MRI is the gold standard for evaluation of the juxta-articular soft
tissues, e.g. the labrum, this method could be improved for additional integration
of the soft tissues into the model.
OP05-31 DOES THE POSITION OF ACETABULAR COMPONENT AFFECT FEMORAL HEAD
AUTOGRAFT HEALING AND SURVIVAL IN DEVELOPMENTAL HIP DYSPLASIA PATIENTS?
Introduction/objectives: Reconstruction of dysplastic acetabulum with
femoral head autograft has been used to achieve full coverage during cup
implantation. Purpose of the study was to determine the effect of cementless cup
positioning on long-term result of femoral head autograft and cup survival in
developmental dysplasia patients.
Methods: We have reviewed 35 patients who had undergone 42 cementless
total hip arthroplasty using femoral head autograft. According to the classification
of Crowe et al. for hip dysplasia, two hips were classified as Type I, 13 as Type
II, 19 as Type III, and eight as Type IV. The mean follow up was 20.3 years (range;
14.8-25.9 years). The position of prosthetic joint was in anatomical region in 22
hips, superior displacement more than 1 cm in 9 hips and less than 1 cm in 11 hips
according to Ranawat triangle. Any sign of graft resorption and migration were
assessed. Survival of components was calculated according to Kaplan-Meier
survivorship analysis.
Results: We did not observe severe resorption and no hips had cup
loosening due to collapsed of grafts. 15 hips (35%) were revised for aseptic
loosening. The mean 20 year survivorship free from aseptic revision of acetabular
component or head and liner exchange was 59.8% and with a worst case scenario was
45%. High hip centre positioning (>1 cm superior and lateral displacement) of the
cup, high acetabular inclination degree (>50 degree), initial host bone coverage
of acetabular component (<50 degree), Crowe types had no significant effect on
the rate of loosening of acetabular cup and femoral head autograft survival.
Conclusions: Position of cementless acetabular cup did not affect
femoral head graft healing and survival. High hip rotation centre had no effect on
cementless cup survival.
OP05-340 TOTAL HIP ARTHROPLASTY (THA) IN DEVELOPMENTAL DYSPLASIA OF THE HIP
(DDH). THE RELEVANCE OF THE ANATOMICAL ROTATION CENTRE TO CLINICAL
OUTCOMES
Oñate Martínez Olascoaga D, Goodarz Mehdikhani K,
Platas Gabriel L, Eusamio Mazagatos B, De Uña Z, Gallego Juncal P, Pozas
Rodriguez LM, Zarzoso Sanchez R
Hospital del Henares, Madrid, Spain
Introduction/objectives: THA is a well proven procedure for DDH. We
study how re-establishing the anatomical centre of rotation of the hip in patients
with DDH is relevant for the clinical outcome.
Methods: A retrospective clinical and radiological evaluation was made
for 49 patients with DDH and THA. 16 patients Crowe types III and IV, 31 Crowe I or
II. There were 29 women and 20 men with a mean age of 65.1 years old. Average
follow-up was 49.2 months. 8 patients presented with bilateral DDH, while 41 were
unilateral. ANOVA test was used for the study of the correlation between centre of
rotation of the hip and clinical outcome.
Results: The mean lowering distance for the centre of rotation of the
hip was 15.04 mm (22.19 in Crowe III-IV, 11.28 in Crowe I-II). The Harris Hip Score
improved from 30.5 to 90.9 points. The rotational centre of the hip was approached
10.4 mm to the true acetabulum, and the abductor strength quotient improved 0.82
points from pre to post-operative. ANOVA test showed no statistical significant
correlation between the anatomical hip centre and clinical outcomes. In terms of
complications: There were two cases of THA dislocation, one acute and the other one
15 months after first surgery; one chronic infection, requiring a revision hip
replacement in two times; and six intraoperative calcar fractures treated with a
non-weight bearing period of six weeks.
Conclusions: Total hip arthroplasty is known to be a safe procedure for
patients with developmental hip dysplasia. Re-establishing the anatomical centre of
rotation of the hip may have an important bearing on clinical outcomes. However our
study has not demonstrated a statistically significant benefit. Further, larger
studies may be beneficial to further explore this.
OP05-359 THE EFFECT OF DISLOCATION TYPE (CROWE TYPES I-IV) ON PELVIC
DEVELOPMENT IN DEVELOPMENTAL DYSPLASIA OF THE HIP
Bilgen öF, Mutlu M, Yaray O
Private Medicabil Hospital, Bursa, Turkey
Introduction/objectives: To examine the effect of dislocation type on
pelvic development in adults with development dysplasia of hip (DDH).
Methods: Retrospectively pre-operative pelvic radiographs were examined
for 57 patients who underwent THA between January 2011 and December 2013 because of
DDH. The patients, who represented 114 hips, had a mean age of 37 years. Both sides
of the pelvis were separated into 3 areas by horizontal lines drawn over the iliac
wings from the ischium inferior, from the acetabular teardrops and from the inferior
sacroiliac joints. The area containing the iliac wing was labelled as area 1, the
acetabulum as area 2 and the ischium as area 3. The height of each area was
calculated as a proportion of the whole hemipelvis height of the same side. The
heights and ratios for each area for healthy hips and for contralateral hips with
DDH were compared.
Results: Of 114 hips, 51 had Crowe type IV dysplasia, 11 had type III, 8
had type II, 10 had type I, and 34 were healthy. When the area heights in Crowe type
II, III, and IV hips were compared, we found that in dysplastic hips, the values for
the area 1 were significantly low, those for the area 2 were significantly high, and
those for area 3 were significantly low. In comparison with the healthy
contralateral hips, the acetabular teardrop distally migrated 10.56 mm in Crowe type
IV hips, 8 mm Crowe type III hips, and 5 mm Crowe type II hips.
Conclusions: In pre-operative planning, surgeons should pay attention
distal migration of the teardrops in patients with DDH. For functional hip joint and
correct soft-tissue balance in DDH, surgeons should take into consideration our
findings regarding the use of reference points for calculating leg-length
discrepancy and the appropriate placement of acetabular components.
OP05-93 TOTAL HIP ARTHROPLASTY IN CROWE TYPE III AND IV DEVELOPMENTAL
DYSPLASIA OF THE HIP
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Total hip arthroplasty (THA) for deficient
acetabulum in patients with developmental dysplasia of the hip (DDH) is technically
demanding and challenging. In current study, we prospectively investigated the
short-term outcomes of THA in patients with Crowe type III or IV DDH.
Methods: Between 2009 and 2014, we operated on 90 dysplastic hips in 87
patients. Three patients underwent bilateral THA. There were 72 females and 18 males
aged 46.3 ± 5.2 years at the time of surgery. For Crowe type IV, proximal femoral
shortening using digastric trochanteric osteotomy was performed followed by
trochanteric wiring. In two of these patients, supracondylar shortening osteotomy
was performed due to the severely deformed knee joint. Shelf graft was used due to
the uncovered cup in 3 patients. Patients were followed for 2.3 ± 1.2 years.
Results: At the final visit, Harris hip score averaged 86.4 ± 7.1. Limb
length discrepancy (LLD) decreased significantly from 6.6 ± 2.5 cm to 1.1 ± 1 cm
(p<0.001). Peroneal nerve palsy developed in one patient resolved after 4 months.
Dislocation occurred in one patient due to falling from stairs. Loosening or
radiolucency and infection were not seen in our patients.
Conclusions: THA in dysplastic hips sufficiently is associated with pain
relief and improved functional status. In addition, proximal femoral shortening with
digastric osteotomy is helpful in patients with Crowe type IV DDH to decrease the
LLD. However, long-term results are necessary to investigate the survival of the
prostheses.
OP05-426 TWO-STAGE HIP REPLACEMENT IN CASE OF CONGENITAL HIGH HIP DISLOCATION
USING SOFT TISSUE EXPANDER
Csernatony Z1, Gyorfi G1,
Huszanyik G2, Mano S3
1Department of Orthopaedics, Debrecen, Hungary; 2Department of
Traumatology, Kenezy Hospital, Debrecen, Hungary; 3Biomechanics
Laboratory, Debrecen, Hungary
Introduction/objectives: Congenital high hip dislocation may lead to
early secondary osteoarthritis, causes Trendelenburg-type, or in bilateral cases
Duchenne-type gait. During hip replacement in case of secondary osteoarthritis
caused by congenital high hip dislocation, the main goal is to implant the
acetabular cup into the primary rotational center. Until now this could be only
achieved by proximal femur osteotomy, for example as described by Paavilainen. In
addition, the risk of neurovascular injury is greater in these cases and the
shortened gluteus medius muscle can obstruct reduction.
Methods: Authors performed two-stage surgery in case of congenital high
hip dislocation, in the first stage a soft tissue expander routinely used by plastic
surgeons is implanted under the gluteus medius muscle. By regular percutaneous
filling up of the expander, the muscle is gradually elongated for 6 weeks. The
second stage is the removal of the expander and the replacement of the affected hip
joint. Authors used the method in 7 hips of 6 patients, the average follow-up is 18,
7 (3-26) months.
Results: In 6 cases during hip replacement the expander visibly reached
the desired effect, in 1 case the expander caused extreme scar tissue formation,
which made the reduction even more difficult during arthroplasty. During the
operations bulk bone grafting was necessary in 6 cases, in 2 cases proximal femur
osteotomy - described by Paavilainen had to be performed. The first results are
encouraging, the highest amount of elongation reached by the technique is 7 cm. In 1
case transitional femoral and sciatic nerve palsy occured. Revision surgery was
performed on 2 occasions, once the displaced greater trochanter had to be refixed,
in another case the acetabular cup had to be revised because of dislocation of the
prosthesis and aseptic loosening of the cup.
Conclusions: Soft tissue expanders are also suitable for the elongation
of muscles and by gradually increasing the volume, the muscle function stays intact.
The technique creates the opportunity of placing the acetabular cup into the primary
rotational center in case of congenital high hip dislocation.
OP05-168 TOTAL HIP ARTHROPLASTY FOR DEVELOPMENTAL DYSPLASIA OF THE HIP WITH
LATERAL UNCOVERAGE OF ACETABULAR COMPONENTS-WHAT ARE LIMITS?
Tikhilov R, Shubnyakov I, Denisov A, Mazourenko
A
Vreden Russian Institute of Traumatology and Orthopaedics, Saint Petersburg, Russian
Federation
Introduction/objectives: Total hip arthroplasty in patients with severe
developmental dysplasia of the hip causes the greatest difficulties due to the
pronounced anatomical and biomechanical changes.
It is impossible to fix the cup into the true acetabulum because of inadequate
coverage. The method of choice in such cases is the implantation with moderate
lateral uncoverage.
Determination of the critical level of acetabular component uncoverage in patients
with developmental dysplasia of the hip (grade 2-3 by Crowe).
Methods: To determine the levels of uncoverage and stability of
components for various efforts used the finite element method with 3D reconstruction
of the hip joint and a mechanical experiment with artificia models of the
pelvis.
Clinical outcomes were evaluated in 96 patients with different degrees of uncoverage
by clinical, radiological examination, Harris hip score and VAS.
Results: In the application of the finite element method and the
mechanical experiment determined the critical values of acetabular component
uncoverage was 20% without screws, and 35% with use of additional fixation
screws.
We evaluated the outcomes of total hip artroplasties in 96 patients. Average
uncoverage was 18,1% (SD 7,99). Most patients showed a high functional results -
75.7 points (SD 13, 08) by Harris Hip Score, 2 points (SD 1,41) on the VAS. There
were no signs of acetabular component loosening in all patients.
Conclusions: The installation of the acetabular component in total hip
replacement with cup uncoverage up to 20% is allowed without screws, and 35% with
additional fixing screws.
OP05-293 IMPACT OF THE FIXING METHOD ON ACETABULAR OFFSET IN DYSPLASTIC
HIP-JOINT
Kolodziejczyk K, Czwojdzinski A, Sionek A, Czubak
J
The Adam Gruca Public Hospital, CMKP Warsaw, Otwock, Poland
Introduction/objectives: Hip dysplasia is one of the main causes of
early developing osteoarthritis. In the most advanced form of osteoarthritis the
treatment method of first choice is endoprosthesis implantation. However defectively
developed acetabulum and subluxated/luxated hip lead to many problems with proper
implantation and orientation of components.
Methods: We retrospectively reviewed the radiographs of 91 patients (96
hips, mean age 42 years, 70 females and 21 males) with hip dysplasia treated
surgically by total hip arthroplasty from 2013 to 2015. The control group was 70
patients (70 hips, mean age 35 years, 53 females and 17 males) without the hip
dysplasia diagnosis treated in our hospital. Radiographic measurements included
medialization (length between the midline of the body and the most medial edge of
the femoral head/endoprosthesis head) and distalization (length between the baseline
joining the greater ischial tuberosities of ischial bones and most lower edge of the
femoral head/endoprosthesis head) parameters indirectly describing acetabular
offset. The severity of dysplasia was defined according to Crowe classification.
Results: Based on the Crowe classification 28% patients have I degree of
dysplasia, 27% - II, 24% - III and 21% - IV. The mean medialization in study group
decrease from 97 mm before surgery to 79 mm after total hip replacement. The mean
distalization was respectively 76 mm and 57 mm. In control group mean medialization
was 78 mm and mean distalization - 47 mm.
Conclusions: Significant changes of medialization and distalization
parameters, means restoration of proper acetabular offset, create good conditions
for normal function of the hip joint. It is important to strive for hip acetabulum
replacement implantation in anatomical location.
OP05-234 LATERAL RIM MESH IN PRIMARY TOTAL HIP ARTHROPLASTY: A SUITABLE OPTION
TO RECONSTRUCT SEGMENTAL ACETABULAR BONE DEFECTS IN YOUNG PATIENTS?
Colo E, Leenders LAM, Rijnen WHC, Schreurs BW,
Hannink G
Radboudumc, Nijmegen, The Netherlands
Introduction/objectives: Several methods have been developed to
reconstruct lateral acetabular defects, which are often present in young patients.
In our institute we use impaction bone grafting (IBG) combined with a cemented cup
and if needed, a lateral rim mesh is used for superolateral segmental wall defects.
Some reports of these meshes in revision THA surgery show disappointing results.
However, no studies have described the results of these meshes in primary THA,
especially not in young patients. We performed a retrospective observational study
to evaluate the effect of a lateral rim mesh on the survival of primary THA in
patients under 50 years at surgery.
Methods: We compared 257 primary THAs with IBG and a lateral rim mesh
(mesh group) with 343 THAs that received IBG without a lateral rim mesh (no-mesh
group). Multivariable Cox regression analysis was used to analyse the effect of the
rim mesh on the survival of only the cup. Additionally, Kaplan-Meier (KM) analysis
was performed.
Results: The unadjusted Hazard Ratio (HR) was 0.58 (95% CI 0.24-1.42)
with aseptic loosening as the endpoint. Adjusted for potential confounders, the HR
for cup revision for aseptic loosening was 0.42 (95% CI 0.13-1.35). KM-analysis
showed a 10-year survival for aseptic loosening of the cup of 98% (95% CI 95-100) in
the mesh group and 94% (95% CI 89-98) in the no-mesh group (p = 0.30). A 15-year
survival for aseptic loosening of the cup of 90% (95% CI 81-100) in the mesh group
and 85% (95% CI 77-94) in the no-mesh group (p = 0.23) was found.
Conclusions: Reconstruction with the use of an acetabular lateral rim
mesh in segmental wall defects, combined with impaction bone grafting and a cemented
cup, provides a safe and effective solution to reconstruct acetabular defects in
young patients requiring THA.
OP05-80 THE LONG-TERM RESULTS OF CEMENTLESS ANATOMICAL SHORT STEM ESPECIALLY
MADE FOR DDH PATIENTS
Matsubara M
Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan
Introduction/objectives: The long-term results of ten years or more, of
the cementless anatomical short stem, which was developed especially for DDH femur,
were carried out by X-ray and clinical evaluation.
Methods: 95 cases of osteoarthritis following DDH were treated with the
cementless anatomical short stem, CentPillarTM from August 2004 – September 2005.
The effective length of the stem is 80 mm for the smallest (#1), to 105 mm for the
largest (#8). 84 hips of female and 11 of male were involved in this study. The
average age at surgery was 59 years, and the average BMI was 23.4. The mean follow
up was eleven years with a minimum of ten. Stress shielding by Engh et al.: SS,
Cancellous condensation: CC, Reactive line: RL, and Cortical Hypertrophy; CH were
evaluated at each zone by Gruen with the radiogram taken during the last visit, and
clinical performance was evaluated with the Harris Hip Score.
Results: One stem that had been implanted to osteoporotic bone was
revised because of loosening but no post-operative dislocation occurred. One case
had an intra-operative proximal femoral fracture, and it was stably reduced with
circulage wiring. Stem subsidence was observed in 6 hips in the early series, and
the average depth was 1.5 mm. No greater than grade 2 SS were observed and CC at
Gruen's zone 2 and 6 in all cases. RL were observed in 47 hips at zone 3, 4, 5, and
CH were seen in 9 hips at zone 2, 6, 7, and 55 points at pre-operative HHS had
improved to 90 points at the last visit.
Conclusions: The CentPillar stem is fit and fill in the proximal, with
strong emphasis on particularly the fit. It is a system that has been developed for
DDH, and achievement of good fixation over a long period of time has been
proven.
OP06 Functional Outcome
OP06-441 EFFECTS OF LOCAL INFILTRATION ANALGESIA ON FUNCTIONAL OUTCOME AND
LENGTH OF STAY IN PATIENTS WITH TOTAL HIP ARTHROPLASTY: A RANDOMIZED CONTROLLED
TRIAL
Unver B, Yuksel E, Kalkan S, Maltepe F, Karatosun
V
Dokuz Eylül University, Izmir, Turkey
Introduction/objectives: In recent years, there has been an increasing
interest in local infiltration analgesia (LIA). Because, LIA is a simple,
surgeon-administered technique for the treatment of postoperative pain after joint
arthroplasty. However, there are contradictory results about efficacy and effects of
LIA in patients with Total Hip Arthroplasty (THA). The purpose of this study was to
investigate the effects LIA on functional outcomes and length of stay in patients
with THA.
Methods: A total of 43 patients (LIA group: 17, placebo group: 26) with
THA were recruited. After surgery, all patients received standard post-operative
treatment. After operation, active range of motion, hip function score [Harris Hip
Score (HHS)] and length of hospital stay (LOS) were evaluated. Functional activities
were evaluated using the Iowa Level of Assistance Scale, and walking speed was
evaluated using the Iowa Ambulation Velocity Scale. The investigators were blinded
the groups.
Results: There was a significant difference in terms of the Iowa level
of assistance scale score. Higher Iowa Level of Assistance Scale score in LIA group
(Iowa I: p = 0.034, Iowa II: p = 0.020, Iowa III: p = 0.044, respectively). There
were no significant differences between the groups for active range of motion,
functional score (HHS), walking speed and LOS.
Conclusions: Although, LIA have provided superior Iowa level of
assistance scale score. LIA technique did not provide additional impact on LOS.
Because LOS depends on many other factors. LIA have no effects on range of motion,
functional score and walking speed in patients with THA. In conclusion, LIA did not
provide additional impact on active range of motion, functional score (HHS), walking
speed and LOS compared with placebo injection in patients with THA.
OP06-310 EARLY HOSPITAL READMISSION AFTER TOTAL HIP REPLACEMENT: ETIOLOGY,
RISK FACTORS AND OUTCOMES
Garcia P, Lima G, Garcia P, Kimura O, Freitas E,
Fernandes M
Institute Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: The hospital readmission after total hip
arthroplasty (THA) has been considered low, but imposes additional logistical and
financial strain on the health system. Recognize the causes of readmission after
discharge can identify errors in the protocols used. The objective was to analyse
the causes associated with hospital readmission within ninety days after the
THA.
Methods: This is a longitudinal, descriptive and prospective study. All
patients readmitted during one year were followed. Exclusion criteria were loss of
follow up or follow-up less than 90 days, incomplete pre-operative records and
radiographic evaluation absent. The use of cemented implant was based according to
the criteria of Dorr and Spotorno.
Results: There were performed 672 primary total hip replacements. The
sample consisted of 67 patients with a mean age of 57.9 years (The readmission rate
within 90 days after arthroplasty was 9.9%). The average number of days between the
discharge and hospital readmission was 27.3 days (5-87) and the average length of
stay after surgery was 6.6 days (2-31). The main cause related to readmission in
this study was periprosthetic infection (29.8%), followed by dislocation of
arthroplasty (22.3%). There was one death.
Conclusions: Readmission to hospital following hip arthroplasty
replacement is not uncommon. Prolonged hospital admissions lead to increased cost to
the hospital as well as decreased volume of surgical procedures performed. Other
issues, including nosocomial infections may be impacted by length of stay.
Conversely, premature discharge from hospital may lead to complications occurring at
home that would more safely be dealt with in hospital.
OP06-327 TEST-RETEST RELIABILITY AND MINIMAL DETECTABLE CHANGE OF THE TIMED UP
AND GO TEST AND THE TWO MINUTE WALK TEST IN PATIENTS WITH TOTAL HIP
ARTHROPLASTY
Introduction/objectives: Performance-based measures are often used in
assessment of physical function for patients with lower limb arthroplasty. Balance
and gait assessment tests such as Two Minute Walk Test (2MWT) and Timed up Go Test
(TUG) are two of the most important of these. A measure is only reliable for use
with a particular population. The aim of this study was to investigate the
test-retest reliability and minimal detectable change at the 95% confidence level
(MDC95) of the 2MWT and TUG in patients with total hip arthroplasty (THA).
Methods: Thirty three patients older than 18 years and were at least 6
months had passed since the patient had operated were included in our study.
Patients with THA performed two trials for two tests on the same day. A time break
was provided to rest the patients between the first and second test. During break
time, we advised the patients not to eat or drink with caffeine. Standard methods
and standardized verbal instructions were used in two tests.
Results: The 2MWT and TUG in this study has excellent reliability as
shown in analysis. The intraclass correlation coefficients for the 2MWT and TUG were
0.94 and 0.93, respectively. The standard error of measurements for the 2MWT and TUG
were 7.10 mm and 0.65 seconds, respectively. The MDC95s for the 2MWT and TUG were
19.68 mm and 1.81 seconds, respectively.
Conclusions: The 2MWT and TUG are less time consuming, not using
sophisticated and expensive equipment and simple way to measure the functional level
after THA in the clinical setting. Our results demonstrated these two tests have
excellent test-retest reliability. Clinicians and researchers may use these tests to
quantify even small changes in functional performance and these MDC values to make
accurate statements about the amount of change observed over time for patients with
THA.
OP06-362 EFFECTIVENESS OF BALANCE EXERCISES ON FALLING RISK IN THE ACUTE
POST-OPERATIVE PERIOD FOLLOWING TOTAL HIP ARTHROPLASTY - A PILOT STUDY
Introduction/objectives: Proprioception decreases in patients with total
hip arthroplasty (THA) compared with healthy individuals and as a result, there are
problems in control of movement and balance.
The purpose of this study was to investigate the effectiveness of balance exercises
on falling risk in the acute post-operative period following THA.
Methods: The series consisted of 16 patients (9 female, 7 male) who had
elective THA. At the first post-operative 8 weeks, patients were randomly assigned
to either typical (TE, n = 8) or typical plus balance (TE + + B, n = 8) exercise
groups. The TE group completed typical surgery-specific joint range-of-motion and
muscle strengthening exercises, while the TE + B group completed the typical
exercises plus balance exercises. Patients were assessed pre-operative,
post-operative 8 and post-operative 14 weeks using outcome measures: One leg stand
test, timed 50-foot walk test, 5 repeated sit-to-stand test (STS), and Harris Hip
Scoring. The patients' risk of falling was assessed by Tetrax Balance Assessment
System.
Results: Patients who participated in the TE and B group demonstrated
significantly greater improvement on falling risk and 5 repeated STS test at
post-operative 14 weeks (p<0.05). It was found no significant differences between
TE + B and TE groups in terms of other assessment parameters (p>0.05).
Conclusions: Typical rehabilitation plus balance exercises program
resulted in significantly greater improvements in balance compared to typical
exercises alone, in spite of the limited sample size of patient. Therefore, we think
that risk of falling should be assessed and balance exercises should be applied in
rehabilitation programs of patients with THA.
OP06-419 IMPAIRED RANGE OF HIP MOTION IN PATIENTS REPORTING MOBILITY PROBLEMS
AFTER TOTAL HIP ARTHROPLASTY
Mohaddes M1, Zügner R2,
Tranberg R2, Rolfson O1
1Department of Orthopaedics, Swedish Hip Arthroplasty Register,
Gothenburg, Sweden; 2Department of Orthopaedics, Institute of Clinical
Sciences, Gothenburg, Sweden
Introduction/objectives: Since 1979 the Swedish Hip Arthroplasty
Register (SHAR) has been gathering data on patients being operated with a total hip
prosthesis in Sweden. In 2002 SHAR introduced measurement of patient-reported
outcomes (PROM). Six years later all Swedish hospitals were participating in this
program. PROM-data are collected pre-operatively, 1, 6 and 10 years postoperative.
14% of patients report having mobility problems associated with the operated hip 1
year postoperative. The purpose of this study was to determine whether there was a
difference in range of hip motion between patients reporting mobility problems and
those not reporting any problems in the mobility dimension of EQ-5D one year
post-surgery.
Methods: Patients operated at Sahlgrenska University Hospital during
years 2011-2013, reporting problems with the mobility 1 year postoperatively were
identified (n = 54). 25 patients (Group I) accepted participation. A matched cohort
(Group II, n = 25), reporting no problems with mobility was included as control. A
portable gait analysis instrument (GaitSmart) was used to analyse the gait pattern
2-4 years post-surgery.
Results: Patients reporting problems with mobility had a lower range of
motion in the operated hip during normal walking (p = 0.04).
Conclusions: Our study showed a correlation between patient-reported
mobility problems one-year post surgery and decreased range of hip motion measured
with GaitSmart 2-4 years post-surgery. Further studies are needed to identify the
reasons for mobility problems in patients operated with a hip prosthesis.
OP06-239 BETTER EARLY FUNCTIONAL OUTCOME AFTER SHORT STEM TOTAL HIP
ARTHROPLASTY?
van Beers LWAH1, Scholtes VAB1, van Oldenrijk
J2, Geerdink CH3, Niers BBAM3, Runne
W1, Bhandari M4, Poolman
RW1
1Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands;
2Department of Orthopaedic Surgery, Amsterdam, Academic Medical
Center, The Netherlands; 3Department of Orthopaedic Surgery, Ikazia
Hospital, Rotterdam, The Netherlands; 4Department of Surgery, McMaster
University Hospital, Hamilton, Ontario, Canada
Introduction/objectives: Short Collum Femoris Preserving (CFP)
prosthesis stems follow the anatomical structure of the femoral neck, which
minimizes the risk of tissue damage in total hip arthroplasty (THA). Theoretically,
faster functional recovery could be obtained compared to THA with a conventional
straight stem.
Objectives: To compare the short term functional results on the Hip
disability and Osteoarthritis Outcome Score (HOOS) between uncemented THA with a
short CFP and a conventional straight stem at 3, 12 and 24 months follow-up.
Methods: Prospective, maximally blinded, randomized controlled
multicenter trial. Inclusion criteria: hip osteoarthritis, 18-70y, BMI<40, life
expectancy >5y and anatomical integrity of the femoral neck. Randomization was
performed in the OR to an Alloclassic Zweymuller stem (Zimmer, Warsaw, USA) or a CFP
stem (Waldemar Link, Hamburg, Germany). Primary outcome was the Dutch version of the
HOOS. Secondary outcomes were the Harris Hip Score, Physical Component Scale of the
SF12 and Timed Up and Go test. Patients, researchers and data-analysts were blinded
for type of prosthesis.
Results: A total of 150 patients were randomized and demographics were
similar in both groups (mean age 60 ± 7y; mean BMI 27 ± 4; 71% females; 42% ASA 1;
55% ASA 2:). Mean HOOS significantly improved in the entire group from 37 ± 15
points at baseline to 71 ± 13 points (3 months), 81 ± 15 points (12 months) and 80 ±
16 points (24 months). All other outcomes also improved significantly over time for
the whole group. No significant difference was observed between the different types
of prosthesis.
Conclusions: We found no evidence for a better short term functional
result after short stem THA compared to conventional straight stem THA.
OP06-442 THE FIRST ONE HUNDRED TOTAL HIP ARTHROPLASTIES IN AN OUTPATIENT
SETTING
Coenders M, Mathijssen N, Vehmeijer S
Reinier de Graaf Groep, Delft, The Netherlands
Introduction/objectives: In the last few years there has been a
continued interest in reducing length of hospital stay after primary total hip
arthroplasty (THA). In April 2014 we started with THA in an outpatient setting for
selected patients. The objective of this study was to report our experience with the
first one hundred THAs in an outpatient setting.
Methods: In this prospective cohort study we included all patients who
were planned to receive primary THA in an outpatient setting. Patients with
cardiovascular history and diabetes were excluded. Moreover, patients had to be
motivated and had to have a caretaker at home. Postoperative follow up was 6 weeks,
3 and 12 months. The short form of the Hip disability and Osteoarthritis Outcome
Score (HOOS-PS), Oxford Hip Score (OHS), EQ-5D; and the Numeric Rating Scale (NRS)
for pain in rest and during activity were taken pre-operatively and at 6 weeks, 3
and 12 months postoperatively. Furthermore, anchor questions on patients functioning
in daily living were scored at 6 weeks and 3 and 12 months postoperatively. All
complications were registered.
Results: A total of 113 patients met the inclusion criteria. Thirteen
patients stayed in the hospital mainly because of postoperative nausea or dizziness.
All other 100 patients went home the day of surgery. Of these 100 patients, mean age
was 61.7 years (41-78), mean BMI was 26.8 kg/m2 (20.3-35.1). Mean
HOOS-PS, OHS, EQ-5D and NRS for pain all improved significantly. There was one
readmission after a superficial wound infection without surgical treatment.
Conclusions: This study confirms that outpatient THA can be performed
successfully in a selected group of patients, with satisfying results up to 1 year
postoperatively, and without troublesome side effects or reoperations.
OP06-417 DOES CHANGES IN HEALTH-RELATED QUALITY OF LIFE DETERMINE PATIENT
SATISFACTION AFTER TOTAL HIP REPLACEMENT?
Mohaddes M1, Nemes S2,
Garellick G1, Rolfson O1
1Department of Orthopaedics, Swedish Hip Arthroplasty Register,
Gothenburg, Sweden; 2Swedish Hip Arthroplasty Register, University of
Gothenburg, Gothenburg, Sweden
Introduction/objectives: An important minority of patients receiving
total hip replacement (THR) have inadequate pain relief, limited function or
dissatisfaction with the outcome of surgery. For example, in Sweden 10% of all THR
patients report dissatisfaction one year after THR. The aim of this study was to
explore the relationship between changes in the five dimensions of EQ-5D and
satisfaction one year after THR.
Methods: Data on 41 642 THRs operated between 2008 and 2012 was included
in this study. A univariate regression model was performed to examine the relation
between differences in pre- and one-year postoperative EQ-5D with satisfaction with
outcome of the surgery. In a multivariate linear regression analysis the association
between responses for different dimensions of EQ-5D at one year and satisfaction,
adjusted for confounders was analysed.
Results: According to the univariate regression analyses improvement to
the “no problem” level was associated with greater satisfaction. Adjusting for
confounders, reporting “no problems” in any dimension at the one year was associated
with greater satisfaction compared to “some/extreme problems”. The highest impact on
satisfaction with the outcome at 1 year was found for patients reporting “no
problems” with pain/discomfort (B = −9.66, Delta-R2 = 0.03).
Conclusions: We demonstrated a relationship between changes in the
different dimensions of EQ-5D and satisfaction with the outcome of surgery one year
after THR. Our results indicate that satisfaction is a valid patient-reported
measure reflecting the changes in the different EQ-5D dimensions. Absence of pain
and discomfort at one year had the strongest influence on satisfaction with outcome
of surgery.
OP06-53 INVESTIGATION OF COMMON POSTOPERATIVE DAILY ACTIVITIES INCLUDING SNOW
SHOVELING AND WEEDING FOR PATIENTS AFTER TOTAL HIP ARTHROPLASTY
1Department of Orthopaedic Surgery, Akita University Graduate School of
Medicine, Akita, Japan; 2Akita Hip Research Group, Akita, Japan
Introduction/objectives: Total hip arthroplasty (THA) may limit everyday
mobility. In Japan's northern farming regions, snow shovelling and weeding are
essential daily activities, and sports are a common form of recreation. We
investigated northern Japanese people's performance of these activities
post-THA.
Methods: The study evaluated all patients visiting outpatient
departments post-THA between 2012 and 2014 one month per year. Patient-reported
outcomes were investigated by Japanese Orthopaedic Association Hip Disease
Evaluation Questionnaire (JHEQ). We also determined the Japanese Orthopaedic
Association Hip Score (JOA score) to qualify hip functioning. Participants were 35
males and 192 females, with a mean age of 68.9 (range, 28-89) years. The mean
follow-up period was 42 (range, 1-384) months.
Results: The mean JOA score was 77.4 ± 13.6 and JHEQ was 51.9 ± 17.2. Of
the patients, 64.2% had resumed some or all of the activities we examined, though
35.8% had not; including giving up weeding from a primarily squatting posture
(25.8%), and using a handheld snow shovel (18.2%). The most common reason for giving
up was fear of the implant failing (24.5%), followed by concerns about dislocation
(19.5%). Some patients had resumed weeding and/or shovelling (45.7%) or sports
activities (21.4%) within 1 year of surgery, and the ratios sharply increased after
1 year (75.0%, 36.1%). After 4 years, more had resumed sports activities (50%).
Conclusions: Some patients gave up activities because of concern about
dislocation or damage of their prosthesis, which lowers overall satisfaction
post-THA. Surgeons therefore should sufficiently explain how the THA postoperative
period can affect resumption of routine activities.
OP06-288 CAN PATIENTS REALLY PRACTICE SPORT AFTER THA?
Bonnin M1, Rollier JC2, Ait Si Selmi T1,
Chatelet JC3, Jacquot L2, Chouteau
J2, Fessy MH4
1Centre Orthopédique Santy, Lyon, France; 2Clinique Argonay,
Argonay, France; 3Polyclinique du Beaujolais, Arnas, France;
4Centre Hospitalier Lyon Sud, Pierre Benite, France
Introduction/objectives: To evaluate sport participation after THA.
Methods: Population: 1094 consecutive patients <75 years at surgery,
operated for THA between 2010 and 2013 (Corail-Pinnacle ceramic on ceramic).
Exclusion criteria: previous hip surgery, any revision and associated TKA.
Questionnaire including Oxford Hip Score (OHS), SF12, Forgotten Joint Score (FJS)
and participation in 22 sports grouped in light, intermediate and strenuous sports.
For each sport, the frequency of participation, the motivation, the level and the
existence of pain during participation were quantified. 948 questionnaires were
fully completed. Mean delay with the surgery was 43.5 ± 13 months. Mean age at
surgery was 60.8 ± 9 years.
91% of the patients were satisfied. 54% practice regularly almost one light, 72% one
intermediate and 18% one strenuous sport. Globally, 9% practice regularly
downhill-skiing, 5% running, 2% tennis, 2% cross-country skiing, 1% mountain trail,
1% mountain climbing and 0.4% judo or karate. The rates of participation in the
subgroups of ‘motivated patients’ were respectively 57%, 68%, 70%, 54%, 43%, 40% et
33%. Among non-participants, 10% (ski) to 14% (running) said that they did not
practice because of the operated hip. Among participants, 6% (ski, tennis) to 13%
(running) report hip pain during participation. They was no correlation between pain
and participation levels (r = 0,06 and p = 0,77). Sport participation was correlated
with motivation (p<0,000), level of participation before hip pathology
(p<0,000) and FJS (p = 0,0007).
Conclusions: Sport participation in a non-selected THA population is
similar to control group. In motivated patients participation is high, even for
strenuous sports.
OP06-114 FAST-TRACK SURGERY IN TOTAL HIP ARTHROPLASTY: 5 YEARS EXPERIENCE AND
VALUE- BASED HEALTHCARE RESULTS
van der Weegen W, Hoekstra H, Sijbesma T, Das
D
St. Anna Hospital, Geldrop, The Netherlands
Introduction/objectives: Fast-track surgery principles gain more and
more interest. These optimized clinical pathways focus on optimal management of
surgical stress, post-operative pain and rehabilitation. Value-based health care
principles offset these values against costs, striving for the highest outcomes in a
context of modern cost-effective health care.
Methods: Since 1999 we introduced in a stepwise manner, fast-track
surgery principles for all our Total Hip Arthroplasty (THA) patients, all with
standard posterolateral approach. Starting with the use of short acting anaesthesia
techniques and no drains or catheters, we introduced early mobilization (2013) and a
minimal restrictions protocol after THA surgery 2014).
To monitor outcomes we developed an electronic arthroplasty database system and an
online system to capture patient reported outcomes (PROMS). THA procedures outcomes
(Length of stay (LOS), readmission rate, complication rate and nature, patient
reported outcomes) and costs were yearly analysed in detail.
Results: LOS decreased steadily from an average of 4.4 days (2010) to
2.1 (2015). The readmission rate within 90 days decreased from 6.6% (2014) to 4.4%
(2015). Short term hip dislocation rate (<90 days) remained stable at 1.1%, also
after we stopped prescribing lifestyle precautions after surgery. PROMS results,
including patient satisfaction, have remained high. A significant cost reduction has
been achieved (approximately 150.000 euros for our department comparing 2014 with
2012).
Conclusions: Applying fast-track surgery principles for THA is
challenging to daily routine and requires continuous attention. Significant
reductions in costs can be achieved while maintaining high standards of clinical
outcomes and patient satisfaction.
OP07 Hip Arthroscopy
OP07-228 HIP ARTHROSCOPY FOR PAEDIATRIC AND ADOLESCENT PATHOLOGIES.
INDICATIONS AND OUTCOMES
Capurro Soler B1, Dantas P2,
Más Martínez J3, León García A1, Marques López
F1, Tey Pons M1,4
1Hospital del Mar-Parc de Salut Mar, Barcelona, Spain;
2Hospital CUF Descobertas, Lisboa, Portugal; 3Clínica
Vistahermosa, Alicante, Spain; 4ICATME-Hospital Universitari Quirón
Dexeus, Barcelona, Spain
Introduction/objectives: Hip arthroscopy (HA) continues to grow as a
treatment modality for paediatric and adolescent population. The aim of this study
was to report the current indications and outcomes of HA treatment for paediatric
and adolescent pathologies.
Methods: A case series of 22 hip arthroscopies in 19 patients 18 years
old and younger operated between February 2007 and June 2015 in 3 hospitals by 3
senior surgeons with a minimum of 1 year of follow-up was reviewed. Data was
collected retrospectively from electronic medical records, including the modified
Harris hip score (MHHS) and/or nonarthritic hip score (NAHS), capacity to return to
previous sports activity and complications. Statistical analysis was performed using
SPSS 18.0.
Results: The mean age at the time of HA was 15.6 (10-18) years.
Indications for surgery included 19 femoroacetabular impingement (FAI) (7 were cam
type, 2 pincer, 7 mixed and 3 subspine syndrome), 1 infectious monarthritis, 1
arthrolysis and 1 biopsy-resection of soft tissue tumour.
In FAI cases 57.9% had labral pathology, 90.9% were treated with suture anchor repair
and 9.1% with partial debridement. At a mean follow-up of 3.4 (1 to 7) years with
91% follow-up, the MHHS and NAHS increased from a mean of 78.5 to 96.6 (P<.001)
and 56.5 to 90.0 (p<.002), respectively. 89.5% returned to full sports
activities. Complications included one transient femoral nerve palsy, one instrument
breakage and one anterior hip dislocation after an accident treated with closed
reduction. There were no differences in outcomes between surgeons and hospitals
(p>.08).
Conclusions: HA is a safe procedure for paediatric and adolescent
pathologies, with excellent clinical outcomes, a high percentage of return to sport
activity and low complication rates.
OP07-457 MINI ANTERIOR APPROACH OR HIP ARTHROSCOPY IN TÖNNIS 2
FEMOROACETABULAR IMPINGEMENT CASES, SHOULD WE DO IT?
Introduction/objectives: Femoroacetabular impingement (FAI) is commonly
treated through arthroscopic, mini anterior and safe surgical dislocation
approaches. Conservative surgery in Tönnis 2 degenerative stage is controversial.
The aim of our study was to evaluate the short-term results of Hip arthroscopy and
mini-anterior approach arthroscopically assisted to treat FAI in Tönnis 2
degenerative stage.
Methods: We developed a prospective study of 87 patients with FAI Tönnis
2. 44 patients were treat arthroscopically (group A) and 43 through mini-anterior
approach arthroscopically assisted (Group B). There were 33 female and 54 male, the
mean age was 35,62 years (range 20-49). Conversion rate to THA was our end point for
survival rate. Radiological analysis evaluates alpha angle, joint space, and
acetabular retroversion. Clinical results were evaluated with iHOT 33, HOS and WOMAC
scores and compare between both groups. SPSS 13.0 software was used (SPSS INC,
Chicago, Ill) was used for statistical analysis; p<0,05 was considered to be
significant.
Results: Mean follow up of the cohort was 4,25 years. Demographic
parameters were similar in both groups. Pre-Operative alpha angle was higher in
Group B than in group A (77° vs 55°), however, postoperative alpha angle were
similar (53° vs 49°). In arthroscopic group, one 1 patient (2,3%) was revised to a
THA. At mini-anterior group, five patients (11,6%) were converted into THA
(p<0,05). No significant difference was observed in clinical and radiological
parameters between both groups.
Conclusions: Treatment of FAI in Tönnis 2 degenerative stage show good
results in the short term but higher pre-operative alpha angle should be taken into
account for a tendency of higher conversion rates to THA through mini anterior
approach.
OP07-427 ARTHROSCOPIC CAPSULAR PLICATION FOR THE TREATMENT OF BORDERLINE
DYSPLASIA OF THE HIP IN THE ADOLESCENT POPULATION: A COHORT STUDY WITH MINIMUM
TWO-YEAR FOLLOW-UP
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: Arthroscopic labral treatment and capsular
plication for borderline hip dysplasia has been described with favourable outcomes.
There is a paucity of literature detailing the outcomes of its use in adolescents.
Our purpose was to examine the role of capsular plication in treating adolescents
with borderline dysplasia defined by a lateral centre-edge angle (LCEA) <25°.
Methods: From 2008 to 2013, 168 patients <18 years old underwent hip
arthroscopy. Patients with an LCEA >25°, previous hip surgery, acetabuloplasty,
hip conditions, and capsular repair or release were excluded. Twenty-four patients
underwent arthroscopy for borderline dysplasia. Patient reported outcome (PRO) data
was prospectively collected using five tools: modified Harris Hip Score (mHHS), Hip
Outcome Score Activities of Daily Living (HOS-ADL), Sports Specific Subscale
(HOS-SSS), Non Arthritic Hip Score (NAHS), and Visual Analog Scale (VAS). Revisions
were recorded.
Results: A total of 24 patients met the inclusion criteria, with 21
(87.5%) available for follow-up. The mean age at surgery was 15.8 years (mean
follow-up time: 2.44 years). The mean pre-operative LCEA was 22.1°, which classified
23 patients as mildly dysplastic (LCEA >19° and <25°). At latest follow-up,
all PROs (mHHS, HOS-ADL, HOS-SSS, NAHS) and VAS improved significantly. Two patients
required revision arthroscopy.
Conclusions: This study demonstrates improved PRO outcomes in patients
<18 years old with radiographic evidence of borderline dysplasia. Hip
arthroscopy, including capsular plication, for the treatment of hip pain in
adolescents with borderline dysplasia is an effective treatment option when physical
therapy has not provided relief and periacetabular osteotomy (PAO) is not
indicated.
OP07-438 MID-TERM OUTCOMES AND SURVIVORSHIP OF HIP ARTHROSCOPY FOR THE
TREATMENT OF LABRAL TEARS AND/OR FEMORO-ACETABULAR IMPINGEMENT
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: Mid-term clinical outcomes for patients
undergoing current hip arthroscopic treatments for labral tears and
femoro-acetabular impingement (FAI) have not yet been reported. Additionally, the
general population of clinicians may not be adequately informed of these
pathologies, which may lead to delayed diagnoses.
Methods: We conducted a retrospective review of prospectively collected
data for patients that underwent arthroscopy between February 2008 and December
2010. Patients with previous ipsilateral hip conditions were excluded. The modified
Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score - Sport
Specific Subscale (HOS-SSS), and visual analog scale for pain (VAS) were documented
pre-operatively and at 5 years postoperatively. Patient satisfaction was also
documented. Future revisions, conversions to endpoints (total hip replacement (THR),
hip resurfacing, or dying), and complications were documented.
Results: We analysed 328 hips with a mean follow-up of 69.3 months. A
mean of 25 months between onset of hip symptoms and surgery was observed. Mean
improvements from pre-operatively to latest follow-up were as follows (p<0.0001):
mHHS (61.8-83.2), NAHS (58.9-83.5), HOS-SSS (41.8-71.4), and VAS (5.9-2.2). Mean
satisfaction at follow-up was 7.9. The revision rate was 13%. Survivorship at latest
follow-up was 82%. The only complication >1% in frequency was numbness (3%),
which resolved in 90% of cases.
Conclusions: Hip arthroscopy for the treatment of labral tears and/or
FAI is a safe procedure that demonstrates good mid-term results, high satisfaction,
and 82% survivorship. These pathologies may have delayed a diagnosis, which is
supported by the two-year differential between onset of hip symptoms and surgical
treatment.
OP07-450 HIP ARTHROSCOPY FOR THE TREATMENT OF LABRAL TEARS AND/OR
FEMORO-ACETABULAR IMPINGEMENT IN PATIENTS AGED 50 YEARS OR OLDER: MINIMUM
FIVE-YEAR FOLLOW-UP
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: There is a paucity of documented mid-term
outcomes in patients aged over 50 years. Our purpose was to report minimum five-year
outcomes, survivorship, and risk factors for conversion to total hip replacement
(THR) in non-arthritic patients aged >50 years undergoing hip arthroscopy to
treat labral tears and/or femoro-acetabular impingement (FAI).
Methods: Data were prospectively collected on patients that underwent
hip arthroscopy between February 2008 and December 2010. Patients aged >50 years,
underwent treatment for labral tears and/or FAI, and had pre-operative
patient-reported outcome (PRO) scores including modified Harris Hip Score (mHHS),
Non-Arthritic Hip Score (NAHS), Hip Outcome Score - Sports Specific Subscale
(HOS-SSS), and Visual Analog Scale (VAS) were included. Patients with pre-operative
Tönnis >1, hip conditions, dysplasia, and previous ipsilateral hip surgeries were
excluded.
Results: Of 90 eligible patients, 84 (93.3%) had minimum five-year
follow-up (mean: 68.2 months). PROs and VAS improved at latest follow-up
(p<0.0001). Mean improvements were as follows: mHHS (59.5 to 86), NAHS (57.9 to
85.2), HOS-SSS (37.4 to 73.5), and VAS (5.7 to 1.9). Mean patient satisfaction was
8.2. Five (5.9%) patients required revision arthroscopy. Twenty-six (30.9%)
converted to THR. Risks for THR conversion were high BMI, high pre-operative alpha
angle, male gender, and acetabular and/or femoral head chondral damage.
Conclusions: Hip arthroscopy for the treatment FAI and/or labral tears
in patients over 50 years old demonstrates favourable mid-term outcomes. Risks for
THR conversion included high BMI, male gender, high pre-operative alpha angle, and
chondropathy. Given these findings, patient selection in this age group should be
rigorous.
OP07-436 IN PATIENTS YOUNGER THAN 50 YEARS OLD: MINIMUM FIVE-YEAR OUTCOMES,
SURVIVORSHIP, AND RISK FACTORS FOR REOPERATION
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: Literature reporting mid-term outcomes for
patients <50 years old undergoing hip arthroscopy to treat femoro-acetabular
impingement (FAI) and/or labral tears is limited. This study reports minimum 5-year
patient-reported outcomes (PROs), survivorship, and risk factors for conversion to
total hip arthroplasty (THA).
Methods: Data were prospectively collected/retrospectively reviewed on
625 patients that underwent arthroscopy between February 2008 and December 2010.
Inclusion criteria were age <50 years and pre-operative modified Harris Hip Score
(mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale
(HOS-SSS), and pain (VAS). Hips with Tönnis >1, hip conditions, or previous
ipsilateral hip surgery were excluded.
Results: Of 253 eligible cases, 203 hips (178 patients) had minimum 5
year outcomes (80.2%, mean 69.5 months). Mean age was 34 years (range: 16.2-49.7).
PROs and VAS improved (p<0.0001): mHHS (64.8, 83.3), NAHS (62.1, 84), HOS-SSS
(46.5, 71.7), and VAS (5.9, 2.2). Mean satisfaction was 7.9. Thirty-one hips (15.3%)
required revision (mean 25.1 months). Twenty-nine hips (14.3%) converted to THA
(mean 44.1 months). THA risks included older age (p<0.0001), higher BMI
(p<0.0001), male gender (p = 0.045), ligamentum teres tear (p = 0.01), chondral
defects (p = 0.02), Tönnis 1 (p = 0.01), higher Tönnis angle (p<0.0001), labral
debridement (p = 0.02), microfracture (p<0.0001), capsular release (p = 0.0003),
and lower pre-operative mHHS and NAHS (p = 0.04 and 0.003, respectively).
Conclusions: Hip arthroscopy to treat labral tears and/or FAI in
patients <50 years old demonstrates favourable mid-term outcomes. Numerous risk
factors for conversion to THA in this age group warrant cautious patient selection
for arthroscopy.
OP07-241 ARTHROSCOPIC TREATMENT OF LABRAL TEARS IN PATIENTS AGED 65 YEARS AND
OLDER: A MULTI-CENTER STUDY OF PROSPECTIVELY COLLECTED OUTCOMES
Hartiaan D1, Beradelli R2,
Krych A2, Levy B2, Domb B3
1American Hip Institute, Westmont, USA; 2Mayo Clinic,
Rochester, USA; 3Hinsdale Orthopaedics, American Hip Institute, Westmont,
USA
Introduction/objectives: Hip arthroscopy is traditionally performed on
and studied in younger patients. Current literature suggests that older age has been
predictive of poorer outcomes; however, there is a group of active older patients
who are candidates for hip arthroscopy. Presently, there is no published data on hip
arthroscopy outcomes for patients 65 years or older. The purpose of this
multi-centre study is to investigate clinical outcomes of hip arthroscopy in
patients 65 years or older treated for labral tears with minimum 2-year
follow-up.
Methods: Outcome data were prospectively collected and retrospectively
reviewed in hip arthroscopy patients 65 years or older. Minimum 2-year follow-up
outcomes analysed were Hip Outcome Score (HOS) and Modified Harris Hip Score (mHHS).
A paired student's t-test was performed to determine significant differences between
pre- and post-operative outcome scores.
Results: 19 patients were included with a mean age of 67 (65-75) and
mean follow-up of 33.5 months. The survivorship rate was 89% with two patients
requiring hip arthroplasty. At latest follow-up, mean mHHS, HOS-ADL, and HOS-SSS
scores were 72.2 (43-100), 77 (21-100), and 62.8 (12.5-100) respectively, and the
mean improvement in scores were 10, 15, and 22 with p-values of 0.07, 0.03 and 0.07
respectively. The average patient satisfaction was 8.3 out of 10.
Conclusions: Treatment of patients 65 years or older with
intra-articular hip pain should exhaust all non-operative measures prior to hip
arthroscopy. If patients fail non-operative measures, this study suggests hip
arthroscopy may result in a modest improvement in their functional state, yielding
high patient satisfaction and a high rate of survivorship at 2- years follow-up.
OP07-447 THE RELATIONSHIP BETWEEN ACETABULAR LABRAL TEAR AND ACETABULAR
CHONDRAL DAMAGE WITH THE TYPE OF FEMOROACETABULAR IMPINGEMENT
Suarez-Ahedo C, Gui C, Rabe S, Chaharbakhshi E, Lodhia P, Domb B,
Perets I
American Hip Institute, Westmont, USA
Introduction/objectives: The purpose of this study was to analyse hip
arthroscopy patients in order to determine whether the type of labral tear and
acetabular chondral damage were related to the type of femoroacetabular impingement
(FAI).
Methods: From February 2008 to March 2013, data were prospectively
collected on hip arthroscopy patients. Exclusion criteria were previous hip surgery
or condition and Tönnis >1. Acetabular chondral lesions were described using the
Acetabular Labrum Articular Disruption (ALAD) and Outerbridge classifications.
Labral tears were described using the Seldes classification. Surgical cases with
were matched in a 1: 1: 1 ratio by age, BMI, and gender.
Results: 1187 hip arthroscopy cases met the inclusion criteria. There
were 497 Seldes type 1 cases (41.2%), 373 Seldes type 2 cases (31.4%), and 317
combined Seldes type 1 and 2 cases (26.7%). Matching yielded 163 Seldes type 1, 163
Seldes type 2, and 163 combined. There were no significant demographic differences
and there was no association between labral tear type and impingement morphology
type. Significant differences were found in acetabular chondral damage
(p<0.0001). Seldes type 2 were ALAD grade 1 chondral lesions, while combined
Seldes type labral tears showed more than twice as many ALAD grade 4 lesions
(p<0.05). No significant differences were observed in the grade of femoral head
chondral lesions.
Conclusions: There was no relation between labral tear type and FAI type
in this series. Seldes type 2 labral tears are associated with ALAD grade 1 chondral
lesions, whereas combined Seldes type labral tears showed more than twice the
frequency of ALAD grade 4 lesions (p<0.05).
OP08 Acetabular Revision
OP08-190 BONE MINERAL DENSITY CHANGES OF ACETABULAR IMPACTION BONE GRAFTING IN
REVISION TOTAL HIP ARTHROPLASTY
Gerhardt D1, de Visser E1,
Hendrickx B1, Schreurs W2, van Susante
J1
1Rijnstate Ziekenhuis, Arnhem, The Netherlands; 2Radboud UMC,
Nijmegen, The Netherlands
Introduction/objectives: Impaction bone grafting (IBG) is an established
method in hip revision surgery to compensate a poor bone stock with proven clinical
efficiency. In spite of its proven clinical efficiency there is limited knowledge
about the actual bone remodelling process in the allograft. In this study repeated
bone mineral density (BMD) measurements were used to gain further insight in this
biological process in-vivo. We hypothesized an initial decrease in BMD would be
followed by an increase towards baseline values.
Methods: Dual energy X-ray absorptiometry (DXA) was used to measure BMD
values in 3 regions of interest (ROI) in 20 patients with an acetabular IBG after
revision arthroplasty. A postoperative DXA was used a baseline and DXA was repeated
at 3, 6, 12 and 24 months. In addition the Oxford Hip Score (OHS) and a 0 - to 100
mm visual analogue scale (VAS) for pain and for satisfaction were recorded
simultaneously.
Results: 11 Males and 9 females with mean age at surgery of 70.3 years
(SD 8.7) were included. The overall BMD in the IBG significantly increased 7.4% (SD
10.9) (p<0.05). In the cranial region BMD increased 12.6% (SD 12.9) (p<0.01).
BMD in the medial and caudal ROI showed a non-significant increase of respectively
7.9% (SD 13.7) (p = 0.07) and 2.7% (SD 16.6). Both the OHS and VAS for pain improved
significantly at one year (p<0.01), with a mean VAS for satisfaction of 81
points.
Conclusions: BMD in the allograft gradually increases after IBG for
acetabular revision arthroplasties, particular in the cranial ROI, an initial
decrease was not encountered. BMD changes may be seen as a surrogate measure for
biological bone remodelling and as such indicate apposition of vital new host
bone.
OP08-195 RESULTS OF DUAL MOBILITY POLAR CUPS IN ACETABULAR REVISIONS
Introduction/objectives: The purpose of this study was to summarize our
clinical and radiological results with dual mobility polarcup system for patients
with high dislocation risk.
Methods: We prospectively followed up 27 patients (31 hips) with a mean
age of 66 years (range: 33-89 years) who underwent acetabular reconstruction with
dual mobility polarcup for aseptic loosening in 19 hips, infection treatment as
second or single stage in 10 hips, instability in 2 hips. Isolated acetabular
revision was performed in nine hips and total hip arthroplasty revision was
performed in 22 hips. Cemented stainless steel dual-mobility cup was used in 16 hips
with acetabular reconstruction or reinforcement ring and directly cemented to the
acetabulum in 9 hips with or without allograft. Cementless titanium porous coted
stainless steel dual mobility cup was used in six hips. We evaluated Harris hip
(HHS) and WOMAC scores and examined radiographs for migration, loosening, and
osteolysis. Survival of components was calculated according to Kaplan-Meier
survivorship.
Results: Mean duration of follow-up was 3 years (range; 2-7 years).
Three cups were revised at one month, 4 months and 19 months for aseptic loosening.
There were no dislocations. At last follow up, the mean HHS increased from 42 points
pre-operatively to 86 points. The cumulative survival rate of dual mobility cup was
87% (95% confidence interval (CI) 83.5%-92.8%) at 5 years and the cumulative
survival rate of rTHA was 82% (95% CI 78.6%-88.4%) at 5 years, any revision as the
end point.
Conclusions: Dual mobility cups can provide excellent stability in
patients who underwent acetabular revision surgery with abductor muscle
insufficiency or complex acetabular revision.
OP08-252 PROMISING SHORT-TERM DATA ON DUAL MOBILITY CUPS USED IN REVISION
PERFORMED DUE TO DISLOCATION
Cnudde P, Rolfson O, Kärrholm J, Mohaddes M
Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute of Clinical
Sciences, Gothenburg, Sweden
Introduction/objectives: Dislocation as a primary indication for
revision has been on the increase in Sweden (14% in 2014). The aim of this study was
to review the utilization pattern and outcomes of the dual articular designs used in
acetabular revision surgery in Sweden. The short-term survival of Dual Mobility Cups
(DMC) was compared to traditional designs, used in revisions performed due to
dislocation.
Methods: During years 2004-2014, 1111 (925 cemented) revisions performed
with a DMC were reported to SHAR. About half (n = 426) of these cases were first
time revisions performed due to dislocation. During the same time period 520
dislocations were revised for dislocation using a standard cemented cup. There were
no differences regarding the age, gender and primary diagnosis (p = 0.12) between
the two groups. A second cup revision for all reasons and specifically for
dislocation was used as end-point. Kaplan-Meier analysis was performed.
Results: Survival analysis at 5 years for all reasons (91.6 versus
87.9%, p = 0.002) and especially for reoperation because of instability favours the
DMC group (96.7 versus 90.9%, p<0.0005). These results are comparable to the
available literature.
Conclusions: Our findings indicate that use of a cemented DMC reduces
the short-term risk of a second revision in first time revisions if compared with
classic cup designs. Longer follow-up is needed to establish any long-term clinical
advantages when DMC are used in revisions performed due to dislocation.
OP08-311 ACETABULAR RECONSTRUCTION WITH COMBINATION OF STRUCTURAL ALLOGRAFT
AND VARIOUS SIZES OF GRAIN ALLOGRAFT IN PAPROSKY TYPE 3 BONE DEFICIENCY, SHORT
TO MEDIUM-TERM RESULT
Introduction/objectives: The aims of our study to assess a result of the
surgical technique with grain and structural allograft for total hip replacement
with acetabular defect type 3 according to the Paprosky's classification.
Methods: A retrospectively review in 43 hip reconstructions. There were
17 in 3A and 26 in 3B. Pelvic discontinuity 8. There were 21 aseptic loosening, 5
post hemiarthroplasty, 11 second stage revision after infected total hip
arthroplasty, 5 primary osteoarthritis and one is neglected fracture-dislocation
hip. The reconstructions performed by structural allograft placed first, then two
sizes of grain bone graft by bone mill machine were filled in the space. After all
allografts were placed, 33 cases were used with reinforcement ring and cemented cup,
10 cases with cementless cup.
Results: At a mean follow-up of 41.46 months (3 to 90). At last follow
up, 32(75%) have no complication. 1 (2%) had pain from prominent of the implant and
treated by revision with simple cementless cup after 2 year. 1 (2%) had changed the
position of the cup but no need for revision. 2 cementless cups (5%) had cup
loosening and required revision. 3 (7%) had post-operative dislocations those
treated by opened reduction, Postoperative deep infection was occurred in 4 (9%) but
3 were cured by debridement and 1 by two stages revision arthroplasty. For
acetabular revision from aseptic loosening, 95% (40/42) of the cups were considered
stable at follow-up and all of them had good bone integration. Clinically, the mean
pre-operative Modified Harris Hip Score improved from 29.47 points (13-58) to 73.42
points (60-89).
Conclusions: Our series had shown short to medium-term results that
acetabular reconstruction with combination of structural and grain allograft are
effective.
OP08-90 ACETABULAR REVISION WITH LARGE BONY DEFECTS USING JUMBO CUPS
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: There are several options such as Jumbo cups
have been introduced for management of large bony defects during revising an
acetabular component. In current prospective study, we investigated the midterm the
clinical, radiographic and functional outcomes of revising acetabular component
using Jumbo cups.
Methods: Between 2004 and 2008, 51 consecutive patients underwent
uncemented revision total hip arthroplasty (THA) enrolled in our study. Nine
patients lost during follow up. The remaining patients were followed for 8.6 ± 4.9
years.
Results: Unfortunately, aseptic implant loosening occurred in two
patients who required re-revision surgery. One patient experienced dislocation.
Radiolucency around the bone-implant interface was found in other 4 patients,
however, none of them developed instability. No patient developed infection or
thromboembolic events. The Harris hip score (HHS) averaged 81.4 ± 14.6. Based on the
HHS, the functional outcomes were excellent in 5 patients, good in 17 patients, fair
in 13 patients and poor in 7 patients.
Conclusions: The findings of our study confirm that using Jumbo cups for
acetabular revision with large bony defects can be associated with satisfactory
functional, clinical and radiographic outcomes.
OP08-384 RECONSTRUCTION OF LARGE ACETABULAR DEFECTS WITH PELVIC DISCONTINUITY
THROUGH A CUP-CAGE CONSTRUCT
Wassilew G1, Perka C2
1Charité - Universitätsmedizin Berlin, Centrum für Musculoskeletale
Chirurgie, Berlin, Germany; 2Charité - Universitätsmedizin Berlin,
Centrum für Muskuloskeletale Chirurgie, Berlin, Germany
Introduction/objectives: Restoring normal anatomy and achieving stable
fixation of the acetabular component can be challenging in the presence of severe
acetabular defects and pelvic discontinuity. A cup-cage (CC) construct, where a
highly porous metal cup is additionally stabilized by an ilioischial cage, is an
excellent treatment option for such challenging cases, since it allows for an
ingrowth of the implant to the remaining host bone. The main purpose of this study
was to determine survival rate of the CC procedures.
Methods: Twenty-one hips, with Gross type V defects (pelvic
discontinuity), treated between January 2008 and March 2014 with a CC and a minimum
2-year follow-up were included in this study.
Postoperative clinical and radiological evaluations were performed annually.
Migration, radiographic loosening and osseous consolidation of the pelvic
discontinuity were assessed in comparison to the initial postoperative radiographs.
Failure was defined as cup-revision for any reason.
Results: Twenty-one CC procedures with an average follow-up of 32 months
(range, 24-71 months; SD, 26) months were identified; all were Gross type V defects
(pelvic discontinuity with severe bone loss).
The survival rate was 91%. One CC had nonprogressive radiological migration of the CC
and a brakeage of the ischial flange. One CC was revised to a tripolar cup into the
cage because of recurrent dislocation. Ninety-five percent of the patients shows a
healing of the pelvic discontinuity.
Conclusions: Our results show that a CC is a suitable treatment choice
for pelvic discontinuity. Additionally, it also presents a treatment option for
severe acetabular bone defects, if stable fixation cannot be obtained through a
highly porous metal cup with or without metal augments.
OP08-29 THE USE OF TITANIUM AUGMENTATION COMBINED WITH CEMENTED CUP FOR
ACETABULAR BONE DEFECT IN REVISION THA
Yo H, Ohashi H, Sugama R, Ikawa T
Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Introduction/objectives: Large acetabular defects can be reconstructed
with various methods. In this study, we reported the usefulness of a new material
titanium augment (Regenerex Augment; Biomet). The purpose of this study was to
evaluate (1) the radiographic results of osteointegration between acetabular and
augment, position of the hip centre after surgery (2) the clinical results (3) the
complications related to the surgery.
Methods: We prospectively followed 26 revision THA cases in whom we
reconstructed the acetabulum with a regenerex augment combined with a cemented HXLPE
shell. All 26 cases were followed an average of 32 months. We performed
reconstruction in cases which belong to Paprosky 2A-3B. We obtained follow up
radiographs postoperatively at 1, 3, 6 months and annually. Pre-Operative and
postoperative height of hip centre was measured by radiographs. We used radiographic
signs of osseointegration described by Moore. Activity of daily living was measured
with Japanese Orthopaedic Association Score. Postoperative complication was also
assessed.
Results: 21 of the 26 acetabular reconstructions showed radiographic
sign of osseointegration. The hip centre was located a mean of 45.6 mm above the
interteardrop line pre-operatively, and a mean of 27.3 mm postoperatively. No major
complication related to the surgery occurred. JOA score improved from 57 to 83.
Conclusions: As the results of the limitations and inconsistent results
reported with conventional methods, regenerex titanium augment appears to be useful.
The mid-term results with titanium augments are promising and longer follow up is
required.
OP08-139 TRABECULAR METAL CUPS FOR ACETABULAR REVISION ARTHROPLASTY.
SURVIVORSHIP AND CLINICAL OUTCOMES
Capurro Soler B1, Marí Molina
R1, Gamba C1, Sala Pujals A1, Tey Pons
M1,2, León García A1, Marques López
F1
1Hospital del Mar-Parc de Salut Mar, Barcelona, Spain;
2ICATME-Hospital Universitari Quirón Dexeus, Barcelona, Spain
Introduction/objectives: Trabecular metal cup (TMC) use in acetabular
revision surgery (ARS) has increased worldwide. The study's aim was to assess TMC in
ARS survivorship and clinical outcomes.
Methods: A retrospective study of 165 surgeries using TMC in ARS
conducted between February 2007 and June 2015 was done. Data was obtained from the
hospital's electronic records. Clinical outcomes were assessed using the Merle
d'Aubigné-Postel (MAP) score and radiological evaluation with the Paprosky
classification. Statistical analysis was performed using SPSS 18.0.
Results: In accordance with Paprosky, 67 patients were classified with
defect type 1, 39/2A, 17/2B, 5/2C, 23/3A and 14/3B. The most frequent cause of
revision was aseptic loosening of the acetabulum (46.1%) followed by 2nd
stage septic revision (18.8%). Trabecular metal augments were used in 9.1% of our
ARS. The mean follow-up was 35.3 (6-108) months, with follow-up loss at 4.8%.
The rate of aseptic loosening was 0.6%. The mean MAP score improved from 12.3 to 15.4
(p = 0.001). There were 7.9% intraoperative complications, 0.6% showed marginal
acetabular fracture and 7.3% proximal femur complications. Postoperative
complications presented 7.3% infections, 7.3% dislocations and peroneal nerve palsy
(PNP) at 3.6%. Only cases of Paprosky ≥3 had a higher frequency of PNP lesions (p =
0.045). No differences in survival rates and the postsurgical MAP score between
aseptic and septic revisions, pre-operative Paprosky or intraoperative complications
were found (p>0.05). Only postoperative complications had lower postsurgical MAP
scores (P = 0.001).
Conclusions: The results of TMC in ARS showed significant clinical
improvement with a high survival rate, low aseptic loosening and complications.
OP08-127 DO TRABECULAR METAL CUPS IMPROVE THE RESULTS OF HEMISPHERICAL POROUS
TITANIUM CUPS IN ACETABULAR REVISION SURGERY? A MIDTERM FOLLOW-UP STUDY
Cruz Pardos A, Garcia Rey E, Fernandez Fernandez R,
Ortega Chamarro J, Garcia Cimbrelo E
Hospital la Paz, Madrid, Spain
Introduction/objectives: The use of trabecular metal (TM) cups has
increased in acetabular revision surgery in spite of the good long-term results of
hemispherical porous-coated acetabular cups. We compared the risk of re-revision for
titanium and TM cups in acetabular revision surgery.
Methods: We reviewed 183 acetabular revisions between 1991 and 2015.
Titanium cups were used in 72 cases and TM cups in 111. The most common reason for
revision was aseptic loosening. Paprosky Type 2 bone defect was the most frequent.
Clinical evaluation was assessed according to Merlé-D'Aubigne-Postel scale.
Kaplan-Meier survival analysis was used to assess implant survival, with
radiological failure and re-revision as the endpoint. Log rank test was used to
compare survival between groups. Cox multivariate regression model was used to
assess different risk factors for failure.
Results: We used larger cups and more screws in TM Group (p<0.05).
The Merlé-DÁubigne-Postel improved in both Groups (p<0.001). There were 7
re-revisions; 2 in titanium Group and 5 in TM Group. 2 cups with Paprosky 3B were
revised by aseptic loosening and 5 cups by recurrent dislocation. At 7 years the
cumulative probability of not having re-revision for any reason was 96.9% (95% CI,
92.6%-100%) for titanium Group and 95.3% (95% CI, 90.79%-99.81%) for TM Group (p =
0.41 log rank test). Radiological aseptic cup loosening was observed in 3 hips with
a Paprosky 3B defect. Cox regression analysis showed a higher risk of loosening in
hips with a higher Paprosky defect (p<0.05, hazard risk (HR) 3.04; 95% CI,
0.97-9.54).
Conclusions: Titanium and TM cups are a good option in acetabular
revision surgery in most cases. Further follow-up is necessary to verify if TM cups
can reduce the re-revision rate in long term, compared to less costly porous
titanium cups.
OP08-421 POROUS TANTALUM UNCEMENTED ACETABULAR SHELLS IN TOTAL HIP
REPLACEMENT
de Sandes Kimura O, Freitas E, Linhares Garcia PB,
Leal DDC, Cury Fernandes MB
Institute Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: Tantalum has been introduced in an effort to
enhance osseointegration potential of uncemented components. This study assesses the
fixation of the porous tantalum uncemented acetabular shells in patients undergoing
aseptic revision total hip arthroplasty and primary total hip arthroplasty with bone
defects.
Methods: Our registry identified all revision and primary total hip
cases with porous tantalum cups implanted from 2007 to 2015 in our institution, and
704 cases were identified. Clinical outcomes and radiographs were studied. The
minimum follow up was 12 months and the average was 54 months. Cases were evaluated
prospectively and graduated at least as IIB according to Paprosky Classification for
acetabular defects. Evaluation of loosening based on pre, early and late
postoperative radiographs and the measure of the Merle d'Aubigné score as well.
Results: The reoperation rate was 5%, the major indication was
infection. The Kaplan-Meier survival rate was 100% at 42 months, since none of the
cases showed signs of loosening, clinical or radiographic, considering the removal
due to infection, the rate decreases to 98%. The average Merle d'Aubigné score
increased from a mean of 6.65 points before the revision to a mean of 15.96 points
at the final follow-up (p<0,0001).
Conclusions: The results of porous tantalum acetabular components for
primary and revision total hip arthroplasty demonstrate high rates of initial
stability and apparent ingrowth. Cementless tantalum acetabular shell demonstrated
excellent early clinical and radiographic results and warrants further evaluation in
revision acetabular reconstruction associated with severe acetabular bone
defects.
OP09 Paediatrics
OP09-379 POSTERIOR ROTATIONAL FEMUR OSTEOTOMY IN TREATMENT FOR TYPE II
AVASCULAR NECROSIS IN YOUNG CHILDREN
1Republican Centre for Traumatology and Orthopaedics, Minsk, Belarus;
2Belarusian Research Institute of Trauma and Orthopaedics, Minsk,
Belarus
Introduction/objectives: Growth disturbance of proximal part of femur
after AVN is a serious problem. After surgical treatment of type II AVN by Kalamchi
especially in young children relapse of deformation is often so the femoral head
growth zone is damaged.
Methods: We have formulated a new approach to surgical treatment this
pathology. Unfortunately we are unable to restore normal function of growth zone of
the femoral head, but can transposition plane forming deformation from the most
important in a plane less significant where its formation is not accompanied by
significant variations in anatomy and biomechanics of hip joint.
We used our own technique posterior rotational intertrochanteric osteotomy of the
proximal part of femur with turn femoral head and neck 90° posteriorly. This
osteotomy was performed in 5 children (5 hips) between the ages of 3 to 5 years
(average - 4 years and 7 months).
Results: In all cases, centration of the femoral head in the acetabulum
was restored and joint stability was improved. Wiberg angle has increased an average
of 16,4 (from 9 to 24°) to 25,2 (from 22 to 28°). In all cases, achieved during
operation joint relationships continue throughout the period of observation.
According to Severin assessment system by modified Ziots excellent results were
obtained in 4, good - in 1 cases. The clinical results were assessed according to
McKay's system modified by Zionts, good and excellent results were registered in
100%.
Conclusions: Posterior rotational osteotomy allows changing femoral head
position in three dimensions, provides the deformation relapse prevention and can
use in young children with type II AVN by Kalamchi.
OP09-245 INDIVIDUAL APPROACH TO HIP JOINT ARTHROPLASTY IN CHILDREN
Baskov V, Baindurashvili A, Neverov V, Filippova A,
Bortulev P
The Turner Scientific Research Institute for Children Orthopaedics, Saint Petersburg,
Russian Federation
Introduction/objective: Total hip arthroplasty in children remains a
rare and insufficiently explored way of treatment of coxarthrosis. The task is to
employ hip joint replacement optimization tactics in children.
Material and methods: We performed 238 operations of total hip
arthroplasty in 217 patients aged from 12 to 17 years old diagnosed with the stage 3
coxarthrosis. Before admission to the hospital 176 patients of the total amount
underwent surgical interventions on hip joints, and 86 children among them were
operated on more than once. As a result of the interventions some deficit of bone
mass in the hip joint components was registered that made it difficult to select the
components for endoprosthesis by standard methods - by using 1-dimention X-ray
graphs and templates. Methods of selecting the appropriate implant using a virtual
3D modelling have been developed and applied. The elaborated technique allows to
perform a minimal resect of the bone tissue with the maximum compliance of
principles of stable fixation.
Results: The ongoing monitoring of all operated patients with the
mandatory inspection and X-ray control is performed, the first survey being done 3
months after the surgery followed by at least once per year examination. The maximum
follow up period lasted for 7 years. Cases of instability of the implanted
components have not been identified.
Conclusions: A sufficiently long follow up period and the lack of
post-operative complications allow us to conclude that the method of the virtual 3D
modelling provides the selection of the optimum sized implant components in the
situation of the bone tissue deficit. This ensures a long-term implant functioning
in challenging clinical situations.
OP09-237 THE APPLICATION OF 3D MODELING TECHNOLOGY IN THE FEMUR CORRECTING
OSTEOTOMY AND ILIAC PELVIC OSTEOTOMY
Baindurashvili A, Baskov V, Filippova A, Bortulev
P
The Turner Scientific Research Institute For Children Orthopaedics, Saint Petersburg,
Russian Federation
Introduction/objective: Until recently the pre-surgery planning had been
performed by ‘drawing out’ of one-dimension X-ray graphs. In trying to adjust 1D
models to 3D-shaped bones errors inevitably occurred which brought about distortions
in the set parameters and, consequently, poorer operation results. To work out a
planning protocol and carry out an osteotomy of femur and iliac pelvic osteotomy
using 3D modelling technology.
Materials and methods: The study included 29 hip joint pathologies in
patients aged from 5 to 17 years old. The study was carried out with the use of the
‘Philips Brilliance 16’ computer tomography scan. Using the adapted version of the
original complex soft the research group accomplished a 3D model. For the purposes
of prototyping the following 3D printers were used -«EnvisionTEC's ULTRA 3SP»,
«FLASHFORGE Creators».
Results: The application of 3D modelling technology has made it possible
to do the design of spatial orientation of the bone fragments, calculate accurately
the optimal size and shape of the bone wedge while performing the corrective
osteotomy of the femur, calculate the vector and rotation degree of the acetabulum,
and pre-determine the position of implants for osteosynthesis. In addition, the 3D
printers were used to model the hip joints in order to practice manual skills and
design an individual template for navigation during surgery.
Conclusions: The application of 3D modelling technology in performing
the corrective osteotomy of the femur and iliac osteotomy allows to improve
significantly the quality of surgical treatment because it eliminates the errors
that inevitably happen in planning multiplanar corrections.
OP09-20 DOPPLER ULTRASOUND EXAMINATION OF THE BLOOD SUPPLY TO THE HIP JOINT IN
CHILDREN WITH FEMORAL HEAD DYSTROPHIC CHANGES
Kozhevnikov V, Grigoricheva L, Bobrysheva E
Federal Centre of Traumatology, Orthopaedics Replacement, Barnaul, Russian
Federation
Introduction/objectives: The Doppler ultrasound results of the blood
supply to the hip joints of children with congenital hip dislocation and
Legg-Calve-Perthes (LCPD) disease 1-6 months after the surgery are presented in the
article.
The objective is to assess the significance of Doppler ultrasound of the hip joints
in children with congenital hip dislocation and LCPD.
Methods: 68 patients were being examined from 2010 to 2014. Twenty eight
of them suffered from the LCPD and forty patients had congenital hip dislocation.
All patients were diagnosed with Doppler ultrasound of the hip joint with the
assessment of lateral femoral circumflex artery. Quantitative and qualitative
indices were analysed.
Results: The main index was peak systolic velocity (V max). The
decreased blood velocity was observed in the X-ray of children with severe proximal
hip dislocation and acetabular dysplasia (acetabular angle is >45°). The
difference of velocity indices of unaffected hip and dislocated hip was about 33%.
The velocity indices differed in average in 31% if compared with contralateral side.
The rehabilitation program included traditional physiotherapy and author's method of
hydrodynamic cuff therapy (patent 2454975 issued 10.07.2012). The control Doppler
ultrasound to assess the blood flow of the lateral femoral circumflex artery was
made for children included in the groups of study 4-6 months after surgery. Blood
velocity improved in 15-25%.
Conclusions: The study proved the clinical significance of Doppler
ultrasound. Complex and individual approaches to the diagnosing of hip joint
pathologies with the application of Doppler ultrasound of blood velocity should be
used as a method of dysplastic coxarthrosis prevention in orthopaedic treatment.
OP09-378 TRIPLE PELVIC OSTEOTOMY IN CHILDREN WITH PERTHES DISEASE
Sakalouski A1, Dementsov A2,
Darya S2
1Republican Centre for Traumatology and Orthopaedics, Minsk, Belarus;
2Belarusian Research Institute of Trauma and Orthopaedics, Minsk,
Belarus
Introduction/objectives: The adverse outcome of Perthes' disease occurs
in 50% of cases due to the development of subluxation and deformity of the femoral
head.
Methods: We use our own operative technique of triple pelvic osteotomy
(TPO) for treatment of severe cases of Perthes' disease. Its advantages are: the
only one approach (Smith-Petersen), pelvic bones osteotomies without detachment of
the periosteum, use of ischium osteotomy-octeoclasy, pubic paraacetabular osteotomy,
angle-shaped ilium cut line, minimal pelvic muscles damage, avoidance of direct
contact with large nerve trunks and vessels. We performed 41 TPO in 40 patients aged
from 4 to 15 (average age - 10 years). The indication for TPO was femur subluxation.
The operation was performed on disease stage 2 in 5 patients (12.5%), on stage 3 –
in 18 (45%), on stage 4 – in 7 (17.5%), on stage 5 – in 10 (25%).
Results: In all cases stability of a joint is restored. The Wiberg angle
increased, on the average, from 15 up to 36°, the index of the acetabulum-femoral
head - from 72 up to 100. TPO prevented deformation of the femoral head at early
stages and resulted in the remodelling by spherical acetabulum. During the following
three years the average value of the epiphyseal quotient increased from 56,7 ±
12,01% to 75 9 ± 13,4%, the mean epiphysis-column quotient increased from 72,6 ±
9,9% to 83 ± 12,24%. According to Stulberg 17 joints (74%) were assigned to class
1-2, 6 joints (17%) - to class 3-4, no joints - to class 5. In all cases clinical
results were positive.
Conclusions: So, at early stages of Perthes' disease TPO provides
realization of the principle of «matrix modelling» and improves the form of the
femur proximal part and at later stages of the disease it restores stability of the
hip joint.
OP09-277 LONG-TERM RESULTS OF TRIPLE PELVIC OSTEOTOMY FROM ANTERIOR APPROACH
IN ADOLESCENTS WITH DDH
Sakalouski A
Republican Centre for Traumatology and Orthopaedics, Minsk, Belarus
Introduction/objectives: Residual dysplasia of the hip joint in
adolescents (10-18 years) is complemented with a complex of biomechanical problems.
Triple pelvic osteotomy (TPO) is the operation which permits to solve these
problems.
Methods: TPO occupies the leading position in our clinic (54% of all
operations) in treatment of dysplasia. We've using our own operative technique. The
features of it are: only one approach (Smith-Petersen), pelvic bones osteotomies
without detachment of periosteum, use of ischium osteotomy-octeoclasy, pubic
paraacetabular osteotomy, angle-shaped ilium cut line, minimal pelvic muscles
damage, avoidance of direct contact with large nerve trunks and vessels.
Results: We analysed the results of 62 TPO in 48 patients at 3 years and
then a minimum in 10 years after surgery. After operation the Viberg angle became on
average 41° against −15 ± 15° in the pre-operation period, the loading area
increased in 1,5 times, the Sharp angle decreased on the average from 50° to 25°,
the angle of vertical correspondence increased on the average from 72 to 88°.
Displacement of the acetabulum fomix into a nearly horizontal or horizontal position
is the most important biomechanical result, as it considerably increases the joint
tolerance to load.
The system of Tschauner et al (1992) has been applied to an estimation of the
follow-up results. The results in 2 years were good and excellent in 76% cases,
satisfactory - in 18%, bad - in 6%. The long-termed results (minimum 10 years) were
good and excellent in 68% cases, satisfactory - in 24%, bad - in 8%.
Conclusions: The triple pelvic osteotomy provides stability of a hip
joint and can be the operation of a choice in cases of developmental dysplasia of
the hip in adolescents and provides a long-term positive result.
OP09-283 LONG-TERM RESULTS OF POSTERIOR ROTATIONAL FEMUR OSTEOTOMY IN
TREATMENT OF POSTSEPTIC HIP DEFORMITY IN CHILDREN
Sakalouski A
Republican Centre for Traumatology and Orthopaedics, Minsk, Belarus
Introduction/objectives: Damage of superior part of the femoral head,
incongruity and multiplane deformity in children after hip septic arthritis is a
serious problem, treatment this conditions is very difficult.
Methods: We have used our own technique of intertrochanteric osteotomy
with posterior 45-90° rotation of the femur head and neck in 19 cases in 18 children
with postseptic hip deformity. The aims of operation were reconstruction of the
maximal sphericity of a loaded segment of a femoral head.
Results: The results were studied with the mean follow-up of 7 years 5
months (3 to 25 years). The mean value of the epiphyseal quotient increased from 48
to 98. Its improvement was marked and further during all time till the moment of
bone maturing. The epiphyseal-neck quotient increased to 99 against 58 before the
intervention, the neck-shaft angle became 130 against 120°. In 16 cases the Viberg
angle increased from 18 to 30°, in 3 cases, when the Wiberg angle was less than 20°,
osteotomy was complemented by operation on the pelvis.
According to Severin system (modified Ziots and MacEwen) radiological results were as
follows: 7 joints are referred to group I, 8 - to group II, 2 - to group III and 2 -
to groups IV-V. The clinical results were assessed according to McKay's system,
modified by Zionts, good and excellent results were registered in 79%.
Conclusions: The posterior femoral rotational osteotomy cannot eliminate
the defects of the femoral head but allows maximal use of its intact segments. The
merits of it are: reorientation of femoral head in three dimensions, absence of
angle deformities and negative influence on the growth plate of femoral head,
lengthening of femoral neck and limb.
OP10 Tribology
OP10-242 CAN FEMORAL COMPONENT ALIGNMENT INCREASE METAL ION LEVELS IN
METAL-ON-METAL HIP RESURFACING?
Cuenca Llavall M, León Garcia A, Fraile Suari A,
Marques Lopez F
Hospital del Mar, Barcelona, Spain
Introduction/objectives: Metal ion measurements are accepted for
monitoring wear on metal-on-metal hip replacements. However, clinical management of
patients with metal-on-metal implants is still controversial.
The aim is to determine the relationship between femoral component alignment and
serum metal ion levels as well as to assess the influence of this metal ion levels
on the patients' functionality.
Methods: We retrospectively reviewed 82 patients with MoM hip
resurfacing (Durom) performed in a single centre between 2005 to 2012. Functional
(Harris Hip Score and Postel-Merlé-d'Aubigne tests) and radiographic parameters
(acetabular inclination and femoral component alignment) were collected. Metal ion
measurements, for chromium and cobalt, were determined throughout 2013. Statistical
analysis performed.
Results: 82 patients with a mean age of 52 years (SD 8.8) at a minimum
20 month (mean 5.5 years, range 1-9 years) follow-up. The postoperative functional
results were a HHS: 96.3 (SD 6.7) and PMA: 16.3 (SD 4.4). The radiological analysis
showed a mean femoral component alignment of 143.5°(SD 8.2) and a mean acetabular
inclination of 38.48° (SD 7.9). Serum and urine metal ion measurements were
determined in 56 out of the 82 patients. The fifty-six patients had ion metal levels
below the safe, recommended upper limits. A significant statistical relationship was
identified between serum chromium concentration and angulation of femoral component.
Interestingly, the best functional scores appeared in patients with low ion
levels.
Conclusions: Our data suggest femoral alignment can affect the serum
metal ion levels after metal-on-metal hip resurfacing arthroplasty. The patients
with good functionality had lower metal ion levels than those with poor
functionality.
OP10-10 METAL ION LEVELS IN CERAMIC-ON-CERAMIC THR WITH COBALT-CHROME MODULAR
NECKS
Somers J
Jan Yperman Hospital, Ypres, Belgium
Introduction/objectives: Modular necks in Total Hip Replacement (THR)
can be a source of metal ion release. There are no data to date on the level of
Cobalt (Co) and Chromium (Cr) ions in serum of patients with a Cobalt-Chrome (Co-Cr)
stem and a Co-Cr modular neck.
Methods: Serum ion levels were measured in 20 healthy volunteers with a
well-functioning ceramic on ceramic THR of a particular design. Inclusion criteria
were patients with normal BMI (Body Mass Index) that had a hybrid THR with a
conventional head diameter (28, 32 or 36 mm) CoC bearing couple, used in conjunction
with a modular Co-Cr long neck and a Co-Cr polished tapered stem, and all of the
following criteria: a UCLA Activity Score of minimum 6/10, no other metallic
implants or hardware of any form, a minimum follow-up of 12 months after
implantation.
Results: There were 13 females and 7 males. Average age at implantation
of THR was 63 years. Average Co in serum was 1,71 μg/l; median Co was 1,5 μg/l. No
patient had Co levels higher than 3,7 μg/l. Mean Cr level was 0,49 μg/l; in all but
one patient Cr was below the detection limit (<0,5 μg/l). The subgroup of varus
long necks had higher Co values (mean 1,86 μg/l) than the other types of long necks
(mean of all other long necks 1,56 μg/l).
Conclusions: The hybrid THR Profemur Xm - Procotyle L with a Co-Cr
modular neck on a Co-Cr stem design shows low ion levels (cobalt and chromium) in a
randomly selected group of well-functioning hip patients, but values are higher than
the reported values of this system with a Titanium modularneck.
OP10-206 FRETTING AND CORROSION - WHAT ARE THE INFLUENCING FACTORS?
Introduction/objectives: Fretting corrosion in modular hips is a hot
topic, revision rates of up to 4% have been reported due to adverse reaction to
metal ions and debris. Especially bearing couples with large diameters experience
high frictional moments, leading to increased micro movements at the interfaces.
Goal was to determine the influence of the head material, the taper angle difference
between head and stem, and the roughness of the stem taper on the corrosion
behaviour.
Methods: A) To determine the influence of the head material and the
taper angle difference, matched cohorts of 50 ceramic and 50 CoCr retrievals from
the same manufacturer were analysed for qualitative and quantitative corrosion. B)
For estimating a potential influence of the stem taper roughness, matched cohorts of
60 smooth and 60 micro-grooved retrievals with metal heads were examined for
corrosion. The taper surfaces were qualitatively evaluated.
Results: A) The corrosion scores of stems with ceramic heads were
significantly lower (p = 0,03, Wilcoxon-Test) than with metal heads. The corrosion
phenomena on the CoCr heads were 5 to 10 times higher compared to those on the stem
taper. The taper angle difference (same manufacturer) showed no significant
influence on the corrosion behaviour in both cohorts.
B) No significant influence of the surface structure of the stem taper on the
fretting-corrosion values has been found, neither on the stem taper nor on the head
inner taper.
Conclusions: The results show a significant overall decrease of the
corrosion hazard when ceramic heads are used. This is mainly because most of the
fretting phenomena are observed at the trunnions of the CoCr heads. No influence of
taper angle difference or stem taper roughness on the severity of corrosion
phenomena was observed.
OP10-178 LESSONS LEARNT FROM A PATIENT TRIAL WITH A POLYMER-ON-POLYMER
RESURFACING HIP ARTHROPLASTY
1Rijnstate, Arnhem, The Netherlands; 2Radboud UMC, Nijmegen,
The Netherlands; 3Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The
Netherlands; 4Los Angeles Orthopedic Hospital, Los Angeles, USA
Introduction/objectives: Hip Resurfacing is a treatment option for hip
arthritis in young and active patients. Adverse reactions to metal are a concern and
a search for non-metallic bearing options proceeds. We present results from a safety
and performance study of a new hydrophilic polymer-on-polymer hip resurfacing device
in patients.
Methods: After hip simulator and biocompatibility testing were performed
(ISO 14242-1,3; 10993-3,4,5,10,11), approval was obtained to enrol 15 patients. All
surgeries were done by two experienced hip resurfacing surgeons. Clinical scoring
and radiographs (including MRI) were obtained at regular intervals.
Results: The surgical technique proved feasible with successful
implantation of the new device. Post-op imaging revealed a well-positioned and
well-fixed implant in all 4 initial cases. Patients were pain-free and had good
function for the first 2 months but early cup loosening occurred at 8 weeks and
further enrolment of patients ceased. Eventually all four patients had a similar
early cup failure and revision to conventional THA.
Retrieval analyses confirmed early cup loosening at the implant-PMMA interface.
Femoral components did well. The fixation strength of the implant-PMMA interface
proved insufficient to withstand a small yet measurable contraction in the cup size.
Preclinical tests had failed to show these cement detachments. The loosening was
later reproduced in the lab by exposing cemented cups to simulated biological fluid
divalent ion fluctuations. The results have identified ways to improve fixation and
rendering the material inert to contracture.
Conclusions: Cup loosening led to early failures but measures to address
that are being taken. A hydrophilic all-polymer resurfacing may have a role in the
future of hip resurfacing.
OP10-161 NEW POLYETHYLENES IN TOTAL HIP REPLACEMENT: A 15-YEAR FOLLOW-UP
STUDY
Garcia-Rey E, García-Cimbrelo E, Cruz-Pardos
A
Hospital La Paz, Madrid, Spain
Introduction/objectives: A significant reduction in wear using Durasul
highly cross-linked polyethylene (PE) versus Sulene polyethylene (sterilized with
nitrogen) at 5 years and 10 years was described previously. We ask if the
improvement observed at the earlier follow-up continues at 15 years.
Methods: Between 1999 and 2001, 90 hips underwent surgery using the same
cementless cup and stem: in 45 Allofit cups with Sulene-PE liner and 45 Allofit cups
with Durasul-PE liner, both associated with an Alloclassic stem (28 mm metallic
femoral head). 66 hips of this prospective comparative study were available for a
minimum follow-up of 15 years. The linear femoral head penetration was estimated at
6 weeks, at 6 and 12 months and annually thereafter, using the Dorr method, given
the nonspherical cup shape. All radiographs were evaluated by the same author, who
was not involved in surgery.
Results: 2 hips in the Sulene group showed proximal femoral osteolysis
one of which was revised for stem loosening at 12 years. There was no loosening of
any other prosthetic component. Femoral head penetration in the one year
postoperative radiographs was 0.22 mm (range, 0.08-0.23) for the Sulene group and
0.10 mm (0.04-0.11) for the Durasul group (p<0.001). The mean yearly linear
femoral head penetration was 68.8% lower for the Durasul group: 0.020 + 0.018 mm for
the Durasul and 0.062 + 0.051 mm/year for the Sulene group (p<0.001). Mean linear
femoral head penetration at 15 years was 64.5% less in the Durasul group than in the
Sulene (0.394 + 0.27 mm and 1.108 + 0.78 mm, respectively, p = 0.001).
Conclusions: There is a significant reduction in yearly linear femoral
head penetration with the Durasul-PE. Confirmation that this reduction will result
in less osteolysis requires continued follow-up studies.
OP10-387 LOW INCIDENCE OF COMPLICATIONS WITH THIRD GENERATION 36 MM CERAMIC ON
CERAMIC IN ACTIVE YOUNG ADULT
1University Hospital Infanta Leonor, Madrid, Spain; 2Tan Tock
Seng Hospital, Singapore, Singapore; 3University Hospital Miguel Servet,
Zaragoza, Spain
Introduction/objectives: Ceramic on ceramic (CoC) couple has been used
in young patients. Ceramic breakage and squeaking has been described as main
complications. It has been published higher complication rate with 36 mm CoC size.
The aim of our study was to identify squeaking and ceramic breakage incidence in
young active patients with CoC 36 mm (Biolox Delta®) femoral head in the
short term.
Methods: we present a prospective study of 65 THA with ceramics on
ceramic 36 mm (Biolox Delta®) bearing couple. There were 17 female and 48
male, the mean age was 53,8 years (range 32-66), Patients were evaluated to find out
squeaking and other specific complications regarding their bearing surface as
breakage and dislocation. SPSS 13.0 software was used (SPSS INC, Chicago, Ill) was
used for statistical analysis; p<0,05 was considered to be significant.
Results: Minimum Follow-up time was 12 month. Mean follow up was 4,2
years. No infection was reported. One ceramic liner breakage was detected (1,54%) in
this series at 2 years follow up and was revised to CoC couple bearing. No breakage
of ceramic head was observed. No dislocation cases were presented. All patients were
asked about “hip noise” and 2 patients complain about “squeaking” (3,08%). Both
reported eventual presence of this noise (less than once a moth) and don't required
revision. “Clicking” were more common in this cohort, 8 patients (12,3%) referred
this sound but it does not bother them.
Conclusions: Low rate of complications has been detected in active young
adults with 36 mm CoC. Squeaking (3,08%) and liner breakage (2,24%) are main
specific complication with Biolox delta ceramic on ceramic couple with limited
influence in life quality of our young adult patients.
OP10-408 INFLUENCE OF IMPACTION FORCE AND SUPPORT COMPLIANCE ON INITIAL TAPER
STABILITY
Nevelos J1, Scholl L1, Pierre D2, Lee
R1, Ambrosi M1, Faizan
A1, TenHuisen K1
1Stryker, Mahwah, USA; 2Syracuse University, Syracuse, USA
Introduction/objectives: Assembly of femoral head onto stem remains
non-standardized. Literature shows altering mechanical conditions during seating
affects taper strength and lower assembly load may increase fretting corrosion
during cyclic tests. This suggests overall performance may be affected by head
assembly method. The purpose of this test was to perform bench top studies to
determine influence of impaction force and compliance of support structure on
initial stability of the taper.
Methods: Testing was performed on 36 mm CoCr heads combined with Ti6Al4V
taper analogs with 5.67° taper angle. To evaluate force magnitude, a rigid setup was
used where heads were assembled with loads, 2kN-10kN, using an impaction tower.
Tensile loads were then applied to disassemble taper. To test compliance, rubber
pads were placed underneath the specimens and to the striking surface of the tower
to simulate compliance in the supporting structure and surgical instruments. Aside
from the added damping, testing was performed identical to rigid setup.
Results: Taper stability (assessed by disassembly forces) increased
linearly with assembly force (R2 = 0.95). 46% larger input energy was required in
the compliant group to achieve a comparable impaction force to the rigid group.
However, correlation between assembly load and distraction force was not
affected.
Conclusions: Impact force has a large effect on initial taper stability
and system compliance has a large effect on applied assembly force. The compliant
setup was intended to simulate a surgical scenario where patient and surgical
factors may influence the resulting compliance. Based on results, surgical procedure
and patient variables may have a significant effect on initial taper stability.
OP10-202 OUTCOMES OF UNREVISED HIP RESURFACING PATIENTS: FUNCTION, METAL ION
CONCENTRATIONS AND MARS-MRI RESULTS WITH A MINIMUM 10 YEARS FOLLOW UP
van der Weegen W, Koolen N, Das D, Brakel K, Sijbesma
T
St. Anna Hospital, Geldrop, The Netherlands
Introduction/objectives: Although Metal-on-Metal (MoM) disease has led
to an increased number of revision surgeries, clinical impression is that a
substantial number of patients are doing well with long term (>10 year) follow
up. Since long term results after modern hip resurfacing are scarce, we investigated
clinical outcomes in these patients regarding symptoms and hip function, metal ions
and cross-sectional imaging.
Methods: From a prospective cohort study (n = 298) we included 59
patients >10 years after hip resurfacing surgery (ReCap, Biomet, USA). Oxford Hip
Scores (OHS; excellent: <19, good: 19-26, fair: 27-33; poor: >33) were
collected 10 and 12 years postoperatively. Starting 2012 we intensified our follow
up with routine metal ion concentrations (>7ppb considered abnormal) and Metal
Artefact Reducing Sequence-Magnetic Resonance Imaging (MRI). For MRI, C1, C2 and C3
(Anderson classification) indicated MoM disease. Descriptive statistics were used to
analyse results.
Results: Of the 59 patients, 6 were revised (10.2%), 6 were deceased
(10.2%) and 3 were not available for follow up (5.1%), leaving 44 procedures for
analysis (74.5%). Mean age at surgery was 54.2 years (34-71), 35 were male and
follow up ranged from 10.0 to 11.3 years. At their latest follow up, mean OHS score
was 15.7 points (Excellent = 78%; Good = 14.6%; Fair = 4.9; Poor = 2.4%). Of the
patients with an excellent/good OHS score, 1 had chrome >7ppb but normal MRI. 2
Asymptomatic patients with normal metal ions had moderate MoM disease on MRI.
Conclusions: The majority of patients with a hip resurfacing prosthesis
in situ >10 years, are doing well when followed up clinically, with metal ion
analysis and MARS-MRI. Silent MoM disease is however present in selected cases,
requiring accurate follow up.
OP11 Short Stem
OP11-175 OUR EXPERIENCE WITH SHORT STEM HIP REPLACEMENT SURGERY
Rastogi S, Marya S
Max Superspeciality Hospital, New Delhi, India
Introduction/objectives: Increasingly, active young patients with
advanced hip arthritis are seeking hip replacement surgery. This has increased the
demand for bone and soft tissue preserving surgeries. A short anatomical femoral
stem is an ideal conservative implant in such patients. We report our retrospective
study and 4-year experience with the use of short stems in 50 cases.
Methods: 50 hip replacements were performed on 41 patients between July
2006 and September 2009. Mean age of patient was 45 years. Diagnosis varied from
secondary osteoarthritis, rheumatoid arthritis, post-tubercular arthritis to
dysplastic hips. 9 patients underwent simultaneous bilateral hip replacement. All
patients had a cementless Proxima stem (DePuy, Warsaw) implantation. Follow up was
till September 2013 (minimum 4 years). VAS and Harris hip score were used to assess
clinical outcome. Data was collected thru online CPRS and PACS hospital system. It
was analyzed using statistical software and Kaplan-Meier survival curves.
Results: 40 patients were evaluated at final follow-up, 1 was lost in
FU. There was no peri-operative mortality or serious morbidity, no incidence of skin
breakdown, DVT or dislocation. Complications included lateral cortex fracture,
greater trochanter fracture, aseptic loosening, stem migration, superficial
infection and thigh pain. One patient required stem revision surgery. Stem survival
was 92.7% at 4 years. Harris hip score improved from 52 (preop) to 89.3 at 4 years
and VAS averaged 0.85 at 3 months. 38 (92.7%) patients had good to excellent outcome
at 4 years.
Conclusions: This metaphyseal stem provided clinically and
radiologically stable fixation through snug fit initially, followed by bony
in-growth and was ideally suited to satisfy the requirements of a conservative hip
implant in young patients.
OP11-160 RESTAURATION OF OFFSET IN PARTIAL NECK PRESERVING SHORT STEM HIP
ARTHROPLASTY AND ITS INFLUENCE ON CLINICAL OUTCOME
Köster G1, Poulidis Z2
1Orthopädie und Unfallchirurgie, Schön Klinik Lorsch, Lorsch, Germany;
2Klinik für Orthopädie, Unfall-und Handchirurgie, Darmstadt,
Germany
Introduction/objectives: Restoration of femoral (FO) and acetabular (AO)
offset came out to be a factor influencing clinical outcome in total hip
arthroplasty. Detailed knowledge regarding precision of total offset (TO)
reconstruction in short stem hip arthroplasty and its clinical impact is still
missing.
Methods: In a prospective study 70 patients underwent total hip
arthroplasty using a partial neck preserving short stem. FO, AO and TO were measured
bilaterally on pelvic radiographs pre- and postoperatively. Values were compared on
the operated side (n = 70) and between the operated and non-pathological
contralateral side (n = 54). Clinical and radiological follow up was performed 3 and
24 months postoperatively. Harris Hip Score (HHS), SF12 and UCLA Activity score were
recorded. Clinical results were compared between three offset groups (A: decreased
TO of ≤-3 mm/B: TO between −3 and + 3 mm/C: increased offset of ≥3 mm).
Results: Harris Hip score increased from 46.8 to 91.2 in average, the
physical SF 12 from 31 to 49, the mental SF 12 from 44 to 53, the UCLA Activity
score from 4.9 to 7.6. FO was increased by 3 mm, AO decreased by 5.2 mm in average
resulting in minimal reduction of TO by 1.9 mm in average on the operated side
postoperatively and by 0.68 mm compared with the contralateral non-pathological hip.
Offset alteration was mainly determined by addition on the femoral side (70%) and
reduction on the acetabular side (93%). There was no significant difference in
clinical outcome between cases with decreased, unchanged or increased total
offset.
Conclusions: Offset can be restored adequate with a partial neck
preserving short stem. Within the achieved range of restauration total offset does
have no impact on clinical outcome.
OP11-144 DOES EXTENSIVE VARUS/VALGUS STEM ALIGNMENT IN CALCAR GUIDED
SHORT-STEM THA CAUSE TROUBLE?
1St. Josefs Hospital Wiesbaden, Klinik für Orthopädie und Unfallchirurgie,
Wiesbaden, Germany; 2Unfall-, Hand-und Orthopädische Chirurgie, HELIOS
Dr. Horst Schmidt Kliniken, Wiesbaden, Germany; 3Orthopädische
Universitätsklinik Ulm am RKU, Ulm, Germany
Introduction/objectives: The principle of implanting a calcar-guided
short stem consists of an individual alignment alongside the medial calcar providing
the ability of reconstructing varus and valgus anatomy in a great variety. However,
still there are broad concerns about the safety of extensive varus and valgus
positioning in regard to stability, bony alterations and periprosthetic
fractures.
Methods: 216 calcar-guided short-stems were implanted allowing full
weight bearing. Patients were divided into five groups (A-E) of different
postoperative CCD angles, measured on standardized radiographs. Stem tilt as well as
subsidence was assessed by EBRA-FCA in a 2 year FU for each group. Signs for
stress-shielding and cortical hypertrophy were analysed. Additionally HHS and the
incidence of periprosthetic fractures were assessed for each group.
Results: Mean CCD angles in group A-E were 123.3°, 128.0°, 132.4°,
137.5° and 142.5°. After 2 years mean stem-tilt was −0.16°, 0.37°, 0.48°, 0.01° and
0.86° respectively (p = 0.502). Axial subsidence summed up to 1.20 mm, 1.02 mm, 1.44
mm, 1.50 mm and 2.62 mm respectively (p = 0.043). No periprosthetic fractures
occurred and none of the stems had to be revised. Stress-shielding was slightly more
common in valgus groups (D and E), as well as cortical hypertrophy. HHS showed no
difference regarding different groups (p = 0.458).
Conclusions: After 2 years extensive varus positioning does not cause
increased instability in terms of varus/valgus tilt and subsidence. Extensive valgus
positioning is followed by increased subsidence without any clinical correlation.
The overall rate of stress-shielding and cortical hypertrophy is low, with a slight
emphasis on valgus hips. Clinical results in all groups are encouraging. Further
monitoring is mandatory.
OP11-393 “STEMLESS” VERSUS TRADITIONAL IMPLANTS IN TOTAL HIP ARTHROPLASTY: A
RETROSPECTIVE CASE-CONTROL STUDY
Donati F, De Ieso C, Campana V, Sarracco M, Logroscino
G
Fondazione Gemelli U.C.S.C., Rome, Italy
Introduction/objectives: Short stem implants in total hip arthroplasty
allow a theoretical saving of bone and minimally invasive surgery, but there is
still little evidence of their effectiveness compared to conventional long stem
prostheses. The aim of this retrospective case-control study is to evaluate clinical
and radiographic results of short stems compared with traditional prosthesis
implanted in two homogeneous cohorts of patients.
Methods: A total of 96 patients were selected, all with unilateral hip
prosthesis (46 short stems vs 50 long stems), implanted by the same surgeon using a
postero-lateral approach, suffering from primary osteoarthritis, post-traumatic
osteoarthritis and avascular necrosis. All the patients were compared clinically
(HHS, WOMAC, VAS, SF-12) and radiographically (off-set, CD corner, limb length
discrepancy, acetabular inclination, subsidence, osseointegration, heterotopic
ossification).
Results: At a mean follow-up of 39.5 months all the implanted stems were
well positioned and osseointegrated. In both groups, there has been a marked
improvement in pain with a statistically significant advantage in the short stems
group for WOMAC and SF-12 (Physical). Radiographic evaluation, carried out by 3
different blinded surgeons, showed a better recovery of the articular geometry, a CD
corner closest to the contralateral, with a reduction of cortical hypertrophy and
peri-prosthetic stress-shielding in the short stem group. No major complication were
recorded in the two groups.
Conclusions: The increasing use of short stems is justified by the low
invasiveness of these implants, the ability to restore an anatomical articular
geometry, and the good bone response with excellent osseointegration and clinical
results. Long stems showed good results as well.
OP11-432 SHORT STEM AND CONVENTIONAL HIP ARTHROPLASTY COMPARISON: FUNCTIONAL
AND RADIOLOGICAL RESULTS
Kallivokas A, Daivanjna S, Villar R, Bajwa A
Villar Bajwa Practice, London and Cambridge, UK
Introduction/objectives: Short stem hip replacement is a recently
popular method of treating hip arthritis in younger patients. The benefit of using a
short stem is bone conservation. We compared the short-term (minimum 3 years)
clinical and radiological results of a conventional uncemented total hip replacement
stem (Accolade, Stryker) versus a short stem hip replacement (Minihip, Corin).
Methods: A total of 125 Minihip stems and 124 standard Accolade stems
implanted from 2009-2011 were retrospectively evaluated. The evaluation was based on
plain radiographs performed at 6 months, 1-year postoperatively and annually
thereafter. Their clinical status was assessed using the Harris hip score (HHS)
pre-operatively, then postoperatively at 6 weeks, 6 months, 1,2 and 3-year mark.
Results: The HHS was split into function and pain components to evaluate
differences between the groups. The postoperative results for the functional element
of HHS were significantly better (p<0.05) in the Minihip than the Accolade group
of patients. This difference was not clinically significant since the Minimal
Clinical Indicative Difference for HHS is 10 points. All stems showed radiographic
evidence of bony ingrowth. No evidence of stem subsidence was found in any group One
Accolade stem was revised for infection.
Conclusions: Our study suggests the results of short stem hip
replacements are comparable to conventional stems. They show adequate
osteointegration without need for diaphyseal fixation and no increase in revision
rates. The functional scores appear to be better, but not clinically significant in
the short-stem group. Short stem arthroplasty can be recommended as an optimal
choice for use in patients with good bone quality especially the younger cohort who
are expected to require revision in the future.
OP11-353 EARLY FUNCTIONAL RECOVERY AFTER CEMENTLESS TOTAL HIP ARTHROPLASTY
(THA) WITH A METAPHYSEAL SHORT STEM
Giannini M, Zagra L
IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
Introduction/objectives: The increasing demand for better quality of
life has led to extend THA to younger patients, who have higher expectations to
return to an active lifestyle. This prospective study aims to assess the patient
functional recovery with a novel metaphyseal short stem.
Methods: 76 patients (80 hips) underwent THA; there were 28% women and
72% men, with mean age of 54 ± 10 years. Radiographic, clinical (HHS), PROMs (VAS,
HOOS, UCLA) analysis were performed pre-operatively (T0), and postoperatively at 6
weeks (T1), 6 (T2), and 12 (T3) months. Changes in HHS/HOOS were assessed using the
Student's t-test while the Wilcoxon test was used on UCLA/VAS.
Results: Significant early functional recovery was observed in all
sub-scores (p<0.0001), with mean HOOS function ADL (from T0: 40 ± 17; to T1: 78 ±
16; to T2: 91 ± 9), HOOS function Sport/Rec (from T0: 22 ± 17; to T1: 60 ± 22; to
T2: 78 ± 15), UCLA activity (from T0: 5 ± 2; to T1: 7 ± 2; to T2: 9 ± 1) sub-scores
doubling by T1/T2. These results were confirmed at T3 (HOOS- ADL: 92 ± 12;
HOOS-Sport/Rec: 83 ± 17; UCLA activity: 10 ± 17). Mean HHS (from T0: 49 ± 13; to T1:
84 ± 13; to T2: 94 ± 5; to T3: 95 ± 5) also doubled by T2 (p<0.0001). Mean UCLA
pain (from T0: 3 ± 1,5; to T1: 8± 2; to T2: 9 ± 1; to T3: 9± 1), as well as VAS
pain, HOOS pain and HHS pain sub-scores, demonstrated substantial pain relief
already at T1 (p<0.0001). X-rays showed good implant stability, without any sign
of subsidence and medial/lateral tilt. Asymptomatic non-progressive RLs were
observed in 3 (4%) cases. No metaphyseal stress-shielding, pedestal formation,
calcar resorption were observed. No revision due to implant failure occurred.
Conclusions: Preliminary outcomes indicated significant early functional
recovery with a firm stem proximal fixation.
OP11-212 CLINICAL AND RADIOGRAPHIC RESULTS WITH A NEW SHORT STEM AT 5 YEARS OF
FOLLOW-UP
Loppini M, Astore F, Caldarella E, Della Rocca F,
Mazziotta G, Ricci D, Ruggeri R, Santoro G, Traverso F, Grappiolo G
Humanitas Research Hospital, Rozzano, Milan, Italy
Introduction/objectives: Conventional uncemented stems could cause
significant reduction of the trochanteric bone stock, long stem in the femoral shaft
and stress shielding. GTS is a new short stem that aims to spare the trochanteric
region and limit the invasion of the femoral canal in primary total hip replacement
(THA). The aim was to evaluate the clinical and radiographic results of GTS stem at
5 years of follow-up.
Methods: We prospectively enrolled 109 patients (M:F = 62:47) (115 hips)
who underwent primary THA with a mean age of 58 years (20-80). Pre-Operative
diagnosis was primary osteoarthritis (76%), osteoarthritis secondary to hip
dysplasia (17%), post-traumatic arthritis (4%), avascular necrosis of the femoral
head (3%). The mean follow-up was 61.8 months (60-63). Survivorship analysis was
performed with revision for any reason as the endpoint.
Results: The Harris Hip Score increased from 39.4 ± 5.4 pre-operatively
to 97.3 ± 8.2 postoperatively (p<0.0001). No patient reported thigh pain.
Clinical picture after surgery was rated as very satisfactory and satisfactory by
76% and 17% of patients, respectively. At radiographic follow-up, no patients showed
stress shielding. Cortical hypertrophy in the femoral shaft was detected in 1 (1%)
hip. Heterotopic ossification was found in 11 (9%) hips, but none required surgical
removal. Varus positioning (3°-5°) of the stem was reported in 14 (13%) hips.
Intraoperative periprosthetic fractures were reported in 2 (2%) hips. At 5 year of
follow-up, the cumulative survival rate was 98.3%. One (1%) stem was revised because
of aseptic loosening, and one (1%) because of dislocation.
Conclusions: GTS stem provides excellent clinical and radiological
findings in patients undergoing primary THA at minimum 5 years of follow-up.
OP12 Hip & spine
OP12-210 ANALYSIS OF THE FUNCTIONAL PELVIC ORIENTATION IN THE SAGITTAL PLANE:
A RADIOGRAPHIC STUDY WITH EOS 2D/3D TECHNOLOGY
Loppini M, Astore F, Caldarella E, Della Rocca A,
Della Rocca F, Ricci D, Grappiolo G
Humanitas Research Hospital, Rozzano, Milan, Italy
Introduction/objectives: In the sagittal plane, each subject is
characterized by an anatomical parameter (pelvic incidence, PI) representing pelvic
thickness. Sagittal pelvic orientation can be expressed by functional parameters
such as anterior pelvic plane angle (APPA), pelvic tilt angle (PT) and sacral slope
(SS). We investigated the relationship between PI with APPA, PT and SS values in
standing and sitting positions.
Methods: We prospectively enrolled 109 consecutive patients (M:F =
43:66) (109 hips) eligible for a primary total hip arthroplasty (THA). Average age
was 63.4 years (15-85) at the time of the index procedure. EOS 2D/3D radiography was
performed in standing and sitting positions before THA to evaluate the functional
pelvic orientation. 3D images took into account the patient-specific sagittal
balance measuring APPA, PT, SS and PI.
Results: In standing position, functional parameters measured 5° ± 7.1
for APPA, 11° ± 8.3 for PT, 43° ± 8.5 for SS, and 53° ± 10.9 for PI. In sitting
position, they were −18° ± 10.4 for APPA, 34° ± 11.8 for PT, 20° ± 12.6 for SS, and
54° ± 10.9 for PI. There was no significant difference between men and women in
terms of the functional parameter values in both positions. No relationship was
found between values of APPA and PI in both positions. SS correlated with PI in
standing (r = 0.66; P<0.0001; R2 = 0.44) and sitting (r = 0.51; P<0.0001; R2 =
0.26). PT correlated with PI in standing (r = 0.65; P<0.0001; R2 = 0.42) and
sitting (r = 0.38; P<0.0001; R2 = 0.14).
Conclusions: The SS is the pelvic functional parameter showing the
higher correlation with patient-specific pelvic morphology, represented by the PI,
in standing and sitting positions. During hip replacement surgery, the functional
pelvic orientation in the sagittal plane should be evaluated according with SS.
OP12-113 EVALUATION OF DYNAMIC SAGITTAL ALIGNMENT IN ELDERLY PEOPLE WITH
PELVIC RETROVERSION
1Akita University, Akita, Japan; 2Akita Kousei Medical Center,
Akita, Japan; 3Noshiro Kousei Medical Center, Noshiro, Japan;
4Akita Red Cross Hospital, Akita, Japan; 5Yuri Kumiai
General Hospital, Yurihonjo, Japan
Introduction/objectives: Patients with hip joint disease sometimes have
concurrent spine disease, known as hip-spine syndrome. However, few studies have
evaluated dynamic sagittal alignment. In this study, we used a three-dimensional
(3D) musculoskeletal model to evaluate global spinopelvic parameters, including both
spinal inclination and posterior pelvic tilt while standing and walking.
Methods: Twenty-two patients aged over 65 years who could walk without
assistance were enrolled in the present study. Mean patient age was 79.0 ± 0.9
years. Patients with marked pelvic tilt (>20 degrees) measured on standing
lateral radiographs were included. Thirty-five reflective markers were attached to
participants. A 3D motion analysis system (VICON MX) was used to capture the
positions of the markers while the participants were standing and walking. Data
collection was performed at a frequency of 100 Hz. We calculated the sagittal
vertical axis (SVA), pelvic tilt (PT) and T1 pelvic angle (TPA) from the skeletal
model in static (S-SVA, S-PT, S-TPA) and dynamic (D-SVA, D-PT, D-TPA) modes.
Results: The mean PT was 31 ± 7 degrees. D-SVA and D-TPA were
significantly larger than S-SVA and S-TPA, respectively (P<0.0001, P = 0.004).
D-PT was significantly smaller than S-PT (P = 0.03).
Conclusions: We were able to analyse dynamic changes in sagittal
alignment with a 3D skeletal model. Many studies have reported that the posture of
the trunk and pelvis in static standing changes to anteversion during walking. This
study clarified that these mechanisms also apply to elderly patients with pelvic
retroversion.
OP12-120 ARE THE RADIOGRAPHIC INDICES OF PELVIC TILT THE SAME IN DYSPLASTIC
HIP?
Hamamatsu University School of Medicine, Hamamatsu, Japan
Introduction/objectives: In dysplastic hip, not only acetabulum but also
whole pelvis has morphological abnormalities. Therefore, the pelvic tilt evaluated
by the same radiographic index may be different in dysplastic hip. We investigated
the influence of dysplastic hip on the radiographic indices to evaluate the pelvic
tilt.
Methods: DICOM data acquired from CT images to establish a virtual
three-dimensional pelvic bone model utilizing the software for THA planning.
Digitally reconstructed radiographs (DRR) were established using the pelvic bone
models in 35 patients of bilateral acetabular dysplasia (CE angle <20°, 15 male
and 20 female) with 9 different tilt angles (anterior pelvic plane (APP) as a
reference, every five degrees from 20° forward to 20° backward). Control group was
selected from the 70 patients without acetabular dysplasia. On these coronal DRR
images, A (the vertical distance between symphysis and sacrococcygeal joint), C (the
vertical distance between symphysis and sacroiliac joint), D (the transvers diameter
of pelvic foramen), E (the longitudinal diameter of obturator foramen), F (the
transverse distance of obturator foramen) and G (the inter-teardrop distance) were
measured. We investigated the difference of pelvic tilt evaluated by radiographic
indices (A, C, C/D, E, E/F and E/G) between dysplasia and control group.
Results: There were significant differences of pelvic tilt evaluated by
the indices using obturator foramen (E, E/F and E/G) between both groups. On the
APP, the pelvis of the dysplasia group were evaluated average three degrees of
posterior tilt by index E and E/G compare to that of the control.
Conclusions: Radiographic indices of pelvic tilt using obturator foramen
were influenced by dysplastic hip.
OP12-169 CHRONIC PAIN IN THE LUMBOSACRAL SPINE AFTER TOTAL HIP
REPLACEMENT
Denisov A, Shilnikov V, Tikhilov R, Shubnyakov
I
Vreden Russian Institute of Traumatology and Orthopaedics, Saint Petersburg, Russian
Federation
Introduction/objectives: Often, after a seemingly successfully executed
total hip arthroplasty on the background of the restoration movement in the hip
joint, change of length and support ability limbs, progresses clinic of lumbar
osteochondrosis, manifested by pain syndrome.
Methods: The study involved 84 patients after total hip replacement were
divided into two groups:
Patients with coxarthrosis and high grade degenerative changes in the
lumbosacral spine - 45 patients.
Patients with coxarthrosis and low grade degenerative changes in the lower
back - 39 patients.
All patients were examined after total hip replacement (using the scale of Oswestry,
Harris hip scale, VAS).
Results: In 45% of patients of the I group, a significant enhancement of
low back pain with disease progression and regression of pain in 18% of cases. In
70% of cases the patients in II group there was regression of lumbar pain, in 25% of
cases of the dynamics was not noted. Only in 5% of patients was increased pain.
Conclusions: Hip replacement surgery at unexpressed changes of the
lumbar spine significantly reduces chronic pain in the lower back by restoring the
anatomy and biomechanics of the zone. However, with the express prior lesions of the
lumbar spine is deteriorating state of health, the progression of pain and
dissatisfaction expressed by patients arthroplasty. Before total hip arthroplasty,
all patients should be thorough neurological examination. MRI and CT scan is
recommended for all patients with severe pain in the lumbar spine. If you have a
confirmed during a survey of the destruction of the lumbar spine in many cases be
the first step to raise the question of operative treatment in this area of the
back, and in the future-joint arthroplasty.
OP12-205 DISLOCATION OF PRIMARY TOTAL HIP ARTHROPLASTY IS MORE COMMON IN
PATIENTS WITH LUMBAR SPINAL FUSION
1NYU Langone Hospital for Joint Diseases, New York, USA;
2University of North Carolina at Chapel Hill, Chapel Hill, USA;
3Johns Hopkins University, Baltimore, USA; 4Oregon Health
and Science University, Portland, USA; 5University of California, Davis,
Sacramento, USA
Introduction/objectives: Lumbar fusion is known to reduce the variation
in pelvic tilt between standing and sitting by reducing flexibility of the lumbar
spine. Flexibility of the lumbo-pelvic segment theoretically improves stability of a
hip replacement during sitting by increasing anterior clearance and acetabular
anteversion, thus preventing prosthetic impingement. The effect of lumbar fusion on
stability of THA has not been previously investigated.
Methods: Medicare database was searched from 2005 to 2012 for patients
who underwent THA and spinal fusion. PearlDiver software was used to query the
database by ICD-9 procedural code for primary THA and lumbar spinal fusion. The
lumbar fusion and THA patients were then divided into three groups - 1-2 levels
fused, 3-7 levels, and 8+ levels. THA dislocation rates were searched within each
group. Patients undergoing THA but no spinal fusion were used as the control group.
Statistical significant difference between groups was tested with chi-squared test,
and significance at p<0.05.
Results: 2912 patients were identified to have THA after lumbar spinal
fusion (2420 1-2 level, 476 3-7 level) and 2-year follow-up. The control group of
THA patients with no history of spinal fusion consisted of 839,004 patients. The
dislocation rate in the control group was 1.55%. Higher dislocation rates were found
in patients with spinal fusion of 1-2 levels (2.73%, p<0.0001), 3-7 levels
(4.62%, p<0.0001). Patients with 3-7 levels fused had higher dislocation rates
than patients with 1-2 levels fused (p<0.0001).
Conclusions: Patients with a previous history of lumbar spinal fusion
have significantly higher rates of dislocation of their THA than patients without
lumbar spinal fusions, and longer fusion segments also had higher dislocation
rates.
OP12-267 RISK OF TOTAL HIP ARTHROPLASTY DISLOCATION AFTER ADULT SPINAL
DEFORMITY CORRECTION
1NYU Langone Hospital for Joint Diseases, New York, USA;
2Oregon Health and Science University, Portland, USA;
3Hospital for Special Surgery, New York, USA
Introduction/objectives: Adult spinal deformity correction results in
changes in acetabular anteversion. Spinopelvic fusion reduces the protective motion
of the pelvis between sitting and standing to prevent THA dislocation. Our
hypothesis is that spinal deformity correction may result in dislocation of
previously stable THA due to changes in acetabular orientation and fixation to the
pelvis.
Methods: Patients with previously implanted THA were identified from a
prospective database of spinal realignment patients if they had a THA in situ prior
to spinal surgery. Only patients with at least 6 months postoperative follow-up and
visible THA prostheses were included. All postoperative imaging was reviewed. A
chart review was performed to determine the indication for revision THA. Acetabular
orientation and global/regional spinopelvic parameter were measured pre- and
post-SSD correction.
Results: 42 patients met criteria. 27 of these patients underwent a
3-column osteotomy. Four patients (7.2% of patients-5.7% hips) required revision THA
after spinal realignment procedure: all revisions were for recurrent dislocations.
All had stable THAs prior to spinal realignment. All acetabular components were
within Lewinnek's ‘safe zone’ after ASD correction. There was no difference between
the revised and non-revised group in mean anteversion or inclination. All hips
requiring revision were fused to the pelvis as part of their SSD correction.
Conclusions: Dislocation of a previously stable THA is a potential
complication after ASD correction. Instability may be a result of a combination of
change in alignment of the acetabular prosthesis, as well as reduced spinopelvic
motion from spinopelvic fusion.
OP12-270 TOTAL HIP ARTHROPLASTY IN THE SPINAL DEFORMITY POPULATION: DOES
DEGREE OF DEFORMITY AFFECT RATES OF SAFE ZONE PLACEMENT, INSTABILITY, OR
REVISION?
Schwarzkopf R, DelSole E, Errico T, Vigdorchick J,
Buckland A
NYU Langone Medical Center Hospital for Joint Diseases, New York, USA
Introduction/objectives: Spinal deformity has a known deleterious effect
upon the outcomes of THA and acetabular component positioning. This study sought to
evaluate the relationship between severity of spinal deformity parameters and
acetabular cup position, rate of dislocation, and rate of revision among patients
with THAs and concomitant spinal deformity.
Methods: A prospectively database of patients with spinal deformity was
reviewed and patients with THA were identified. The full standing
stereo-radiographic images (EOS) were reviewed. Spinal deformity parameters and
acetabular cup anteversion and inclination were measured. A chart review was
performed to determine dislocation and revision arthroplasty events. Statistical
analysis was performed to determine correlation of deformity with acetabular cup
position. Subgroup analysis was performed for spinal fusion, dislocation events, and
revision THA.
Results: 142 patients were identified with THA and spinal deformity,
with 152 hips. The rate of dislocation was 5.7%, with a revision rate of 3.6% for
instability. Only 42.1% met the radiographic “safe zone” criteria. 7 (77.8%) of the
9 dislocations occurred in patients with acetabular cups outside the safe zone (p =
0.304). Patients with dislocations had significantly higher inclination than those
patients who did not dislocate (p = 0.016), but had no difference in anteversion (p
= 0.646).
Conclusions: In this cohort, patients with THA and concomitant spinal
deformity have a high dislocation rate and a high percentage of acetabular cups
which lie outside the safe zone in the standing position. Known spinal deformity
parameters and the presence of spinal fusion do not correlate strongly with cup
position or dislocation rates.
OP13 Hip Arthroscopy
OP13-445 DOES A PRIOR HIP ARTHROSCOPY AFFECT CLINICAL OUTCOMES IN TOTAL HIP
ARTHROPLASTY? A MATCHED COHORT STUDY
Poultsides L, Sosa B, Lee YY, Oi K, Buly R
Hospital for Special Surgery, New York, USA
Introduction/objectives: The objectives of our study was 1) to compare
functional outcomes 2 years after THA in patients who received prior ipsilateral hip
arthroscopy (HA) compared to patients who did not; 2) identify patient- or
surgery-related factors predicting joint survivorship following HA; and 3) identify
factors associated with better outcome following HA and subsequent THA.
Methods: Between 2000 and 2014, 63 patients (67 hips) underwent HA
followed by THA by a single surgeon. A matched (1:3) control cohort of 189 THA
patients (201 hips) was formed based on age, sex, comorbidity, DOS, BMI, and THA
diagnosis. Diagnosis prior to scope, time from HA to THA, cartilage wear and whether
microfracture or neck debridement was performed were recorded. Modified Harris hip
scores (mHHS) were obtained at preop, 6 weeks, 3 and 6 months, 1 and 2 year.
Results: Regression analysis demonstrated THA controls had worse mHHS at
preop (delta −5.6 [95% CI −8.9,-2.2]; p<0.01) but higher at 2 year post-op (delta
2.8 [95% CI 0.3,5.3]; p = 0.03). Time from scope to THA was 2.38 ± 2.54 years.
Femoral retroversion ([HR] 2.3 [95% CI 1.1,5.1]; p = 0.04) was associated with worse
joint survivorship following HA, whereas diagnosis of labral tear alone (HR 0.2 [95%
CI 0.04,0.8]; p = 0.03 or neck debridement (HR 0.2 [95% CI 0.1,0.8]; p<0.02) were
associated with better joint survival. Scope patients with cartilage wear had a
greater improvement in mHHS 2 year post THA (11.4 ± 3.1; p<0.01) than patients
without.
Conclusions: This study shows that although prior scope improves
outcomes scores prior to THA, at 2 years post THA is associated with less
improvement. Femoral retroversion, and neck debridement and labral tear alone were
associated with worse and better joint survivorship post scope, respectively.
OP13-444 MINIMUM TWO-YEAR OUTCOMES OF HIP ARTHROSCOPY IN PATIENTS WITH
ACETABULAR OVER COVERAGE AND PROFUNDA ACETABULAE IN COMPARISON TO A MATCHED
CONTROL WITH NORMAL ACETABULAR COVERAGE
Chandrasekaran S, Darwish N, Chaharbakhshi E, Suarez-Ahedo C, Lodhia P, Domb
B, Perets I
American Hip Institute, Westmont, USA
Introduction/objectives: The purpose of this study was to report
patterns of clinical presentation, intra-articular derangements, radiological
associations, and minimum two-year outcomes following hip arthroscopy in patients
with a lateral center edge angle (LCEA) >400 and profunda acetabulae (PA) in
comparison to a matched control with normal acetabular coverage.
Methods: Data were collected on all patients undergoing hip arthroscopy
from April 2008 to April 2013. All hip arthroscopy patients with both LCEA >400
and PA without prior hip surgery or condition were included. A 1:1 match was
performed, with a control group of LCEA 250-400, based on age (±3 years), sex, BMI,
Tönnis grade, labral and capsular treatment. Four patient-reported outcome scores
(PROs), Visual Analogue Scale (VAS) for pain, patient satisfaction, and future
surgeries were also recorded.
Results: 39 patients met these criteria for the study group, of which 36
(92.3%) patients had 2-year follow-up. 215 patients met the control group criteria,
of which 183 (85.1%) had 2-year follow-up, and 36 were matched. There was no
difference in range of motion or impingement signs between groups. The study group
had significantly higher radiological markers of over coverage and incidence of
Seldes type 2 tears (50% vs. 19.4%). Both groups had significant improvements in
PROs, but the study group had significantly lower mHHS improvement (13.5 vs. 21.7),
lower patient satisfaction (6.61 vs. 7.91), and higher THA conversion rate (4 vs.
0).
Conclusions: Hip arthroscopy in patients with combined over coverage and
PA is associated with improvements in outcomes at minimum two-year follow-up;
however, the degree of improvement is of lower magnitude compared to matched cohort
with normal coverage.
OP13-413 CLINICAL OUTCOMES OF HIP ARTHROSCOPY IN RADIOGRAPHICALLY DIAGNOSED
RETROVERTED ACETABULA
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: The purpose of this study is to evaluate the
outcomes of hip arthroscopy in patients diagnosed with acetabular retroversion with
plain radiographs using patient reported outcomes, patient satisfaction, and
comparing pre- and post-operative Tönnis grade.
Methods: Pre- and post-operative data were prospectively collected and
retrospectively reviewed on hip arthroscopy patients between June 2008 and February
2012 with radiographically diagnosed with global acetabular retroversion. Outcomes
collected were modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip
Outcome Score- Activities of Daily Living (HOS-ADL) and Sports Specific Subscale
(HOS-SSS), Visual Analog Score (VAS), satisfaction, and complications. The pre- and
post-operative alpha angle, LCEA, ACEA, crossover %, and Tönnis grade were
recorded.
Results: 82 patients met inclusion criteria with an average age of 23
and average follow-up of 39 months. These patients showed statistically significant
improvement in mHHS (65-81), NAHS (65-85), HOS-ADL (69-88), HOS-SSS (47-76) and VAS
(5.9-2.5) (p = <.0001), and had an average satisfaction of 7.4. There were 3
minor complications, none of which required re-operation. One patient underwent hip
arthroplasty at 6 months after hip arthroscopy. 15 patients had greater than 2-year
radiographic follow-up, none of these patients had increased Tönnis grade.
Conclusions: This study demonstrates that hip arthroscopy can
successfully treat femoro-acetabular impingement associated with a globally
retroverted acetabula at a minimum of 2-year follow-up. Survivorship was 99% at 2
years, with one patient requiring arthroplasty. The procedure was extremely safe
with a minor complication rate of 3.6%.
OP13-448 CLINICAL OUTCOMES OF HIP ARTHROSCOPY IN PATIENTS WITH FEMORAL
RETROVERSION: A MATCHED STUDY WITH PATIENTS WITH NORMAL FEMORAL
ANTEVERSION
Hartigan D, Perets I, Walsh J, Chaharbakhshi E, Close
M, Domb B
American Hip Institute, Westmont, USA
Introduction/objectives: The purpose of this study is to compare the
results of arthroscopic treatment of hip pathology in patients with femoral
retroversion to patients with femoral version between 10-20°.
Methods: Between November 2011 and September 2013, 790 hip arthroscopies
were performed at this institution. Of these, 60 hip arthroscopies were performed on
patients with femoral version =<0, calculated on pre-operative MRI scan. These
patients were matched with 60 patients based on BMI, age, Tönnis and femoral
version. Exclusion criteria included: previous hip surgery or condition, abductor
repairs, hips with LCEA <20, Tönnis grade >1, and acetabular profunda and
protrusio. Patient reported outcomes (PROs) were recorded pre-operatively, at 3
months, then annually thereafter. PROs utilized were the mHHS, NAHS, HOS-SSS, and
VAS. Patient satisfaction and radiographs were obtained at these intervals as
well.
Results: Two patients from the non-retroverted group and one from the
retroverted group required total hip arthroplasty at an average of 19.5 and 23 month
respectively. Both the retroverted and non-retroverted groups showed significant
improvement from their pre-operative state in all PROs and VAS (p<0.001); there
were no differences in pre-operative, postoperative, or change in PRO scores. There
was no difference found in progression of osteoarthritis on radiographs between the
groups.
Conclusions: Patients with femoral retroversion reported similar
outcomes compared to patients with normal femoral version when undergoing hip
arthroscopy. Patients in both groups showed significant improvement from the
pre-operative state and no significant progression of osteoarthritis was noted on
radiographs at >2-year follow-up.
OP13-418 DOES THE FEMORAL CAM LESION REGROW AFTER ARTHROSCOPIC FEMOROPLASTY IN
THE SKELETALLY IMMATURE PATIENT WITH AN OPEN FEMORAL HEAD PHYSIS? RADIOGRAPHIC
REVIEW AND CLINICAL OUTCOMES WITH MINIMUM TWO-YEAR FOLLOW-UP
Perets I1, Gupta
A1, Chaharbakhshi E1, Hartigan D1, Ashberg
L1, Domb B2
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: Femoral cam lesions causing femoroacetabular
impingement (FAI) is seen and treated with osteoplasty in skeletally immature
patients, though possible cam lesion re-growth has not been examined. This study
examined whether the cam lesion re-grows in patients with open femoral head physes
undergoing femoral osteoplasty during hip arthroscopy for treatment of FAI and
concomitant labral pathology.
Methods: We analysed 11 hips in 10 patients with open femoral head
physes that underwent femoroplasty for cam lesion treatment between October 2008 and
November 2013. Exclusion criteria were pre-operative Tönnis grade >1 and previous
hip conditions. Alpha angle was measured pre-and post-operatively and at 2-year
follow-up. PRO scores, including the modified Harris Hip Score (mHHS), Non-Arthritic
Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), Visual
Analog Scale (VAS), and satisfaction, were collected pre-operatively and at latest
follow-up.
Results: 10 female patients, with a mean age of 14.7 years and mean
follow-up of 35.7 months, met all inclusion and exclusion criteria. Mean alpha angle
was 61.8° pre-operatively and 41.5° 2 weeks postoperatively (p<0.0001). Mean
alpha angle was 40.7° at 2 years post-operatively, which was not significantly
different than 2-weeks postoperatively. No patient had radiographic cam lesion
re-growth. PRO changes were all significant: mHHS (58.5-79.8, p<0.0001), NAHS
(56.8-87.1, p<0.008), HOS-SSS (34.3-78.3, p<0.004), VAS (7.5-1.3,
p<0.0001), and mean satisfaction was 8.7. 2 hips (18.2%) required a revision
arthroscopy at a mean of 24.8 months.
Conclusions: In this cohort, hip arthroscopy treatment for FAI and/or
labral tears is shown to be a safe and favourable intervention, with cam re-growth
unlikely.
OP13-84 FEMORAL NECK FRACTURE AFTER ARTHROSCOPIC FEMOROPLASTY: A SYSTEMATIC
REVIEW OF LITERATURE
Zimmerer A, Miehlke W, Sobau C
ARCUS Sportklinik, Orthopädie und Unfallchirurgie, Pforzheim, Germany
Introduction/objectives: Hip arthroscopy became a safe method in the
last decade. Recent studies specify overall complication rates from 1.3% to 6.4%.
These studies showed differences in the rate of femoral neck fractures.
Methods: Using predetermined inclusion criteria, electronic databases
(EMBASE, MEDLINE, and PubMed) were searched for relevant articles addressing femoral
neck fractures after arthroscopic femoroplasty between January 2000 and December
2015. Inclusion criteria limited our search to English and German language studies
and occurrence of fractures after arthroscopic femoroplasty. Article screening was
conducted in duplicate. Reviewer agreement statistics and descriptive statistics of
the included studies are presented.
Results: Out of 1683 articles retrieved by the literature search, we
were able to include eight publications in this systematic review: five case reports
and three studies investigating complications after hip arthroscopy. The fracture
rate showed a range from 0.07% to 1.9%. One study revealed male sex as a risk
factor, another study described the female gender at risk. All publications showed
that patients have an increased risk with increased age. Another factor seems to be
- at least for men - a taller body height. Two case reports showed an increased risk
with increased bone resection. One study revealed that a resection-depth-ratio of
greater than 18% leads to a 25-fold increased risk of fracture.
Conclusions: This review reveals a fracture rate of approximately 0.1%
after hip arthroscopies. Patients at risk seem to be older than 50 years and/or tall
male. In addition a bone resection depth of more than 10% reduces the load-bearing
capacity. Male Patients seem to have a higher risk, but it is not yet clear whether
sex is a risk factor.
OP13-443 ENDOSCOPIC REPAIR OF PARTIAL THICKNESS UNDERSURFACE TEARS OF THE
ABDUCTOR TENDON (PUSTA): CLINICAL OUTCOMES WITH MINIMUM TWO-YEAR
FOLLOW-UP
Domb B1, Perets I1, Ho
S2, Walsh J1, Close M1, Hartigan
D1
1American Hip Institute, Westmont, USA; 2University of Chicago,
Chicago, USA
Introduction/objectives: Endoscopic trans-tendinous repair has been
previously described as a technique to both identify and treat these tears, but no
outcomes studies have been done on this technique. The purpose of this study is to
report minimum 2-year outcomes of trans-tendinous repairs of Partial thickness Under
Surface Tears of the Abductor (PUSTA) tedon using patient reported outcomes (PROs),
visual analog scale (VAS), and satisfaction.
Methods: All endoscopic trans-tendinous gluteus medius repair patients
between October 2009 and May 2013 were prospectively evaluated. Exclusion criteria
were <2-year follow-up, previous hip surgery, inflammatory arthritis, full
thickness abductor tear, and workers' compensation patients. All patients had
pre-operative strength testing (0-5) and gait observation. Patient satisfaction and
PRO scores were recorded pre-operatively, at 3 months postoperatively, and annually
thereafter. The PRO scores collected were modified-Harris Hip Score (mHHS), Hip
Outcome Score-Activities of Daily Living (HOS-ADL) and Sports Specific Subscale
(HOS-SSS), Non-Arthritic Hip Score (NAHS) and VAS.
Results: There were 25 patients that fit our criteria. Significant
improvement in PRO scores were found for mHHS, HOS- ADL, HOS-SSS, NAHS, and VAS from
54.9-76.2, 50.2-80.6, 30.1-67.3, 51.9-82.4, and 7.1-2.7 respectively (p<0.001).
Eleven patients had appreciable weakness pre-operatively; of these, 7 moved up at
least one strength grade by final follow-up. Fourteen patients had a Trendelenbrug
gait pre-operatively, 12 of them had a normal gait at latest follow-up (p<0.001).
Mean satisfaction was 7.5.
Conclusions: PUSTA lesions can be treated successfully with endoscopic
trans-tendinous repair preserving the intact attachment of superficial fibres of the
gluteus medius.
OP13-381 ARTHROSCOPIC ASSISTED MINI-OPEN APPROACH OF THE HIP FOR THE TREATMENT
OF BENIGN TUMOURS OF THE FEMORAL HEAD AND NECK-A CASE SERIES OF 6
PATIENTS
Ezechieli M, Calliess T
Orthopädie MHH Annastift, Hannover, Germany
Introduction/objectives: Bone tumours in general are very rare, benign
in contrast to malign more often though. The femoral head and neck are frequent
localizations for benign tumours and can lead to instability of the bone. Through
the lateral approach there is a limited accessibility and exposure to ensure a
complete curettage. In the present study we present a case series of 6 patients
operated via arthroscopic assisted direct anterior mini-open approach.
Methods: 6 patients were operated arthroscopic assisted direct anterior
mini-open approach AAMOA) between 2013-2015. Two with bone instability due to
fibrose dysplasia of the femoral neck (n = 2), 4 subchondral chondroid tumours of
the femoral head (2 atypic chondroid tumours and 2 chondroblastoma). After a direct
anterior approach and a t-shaped capsulotomy a windowing of the femoral neck was
performed. The curettage was performed followed by biologic reconstruction. In the
two cases of fibrotic dysplasia an additional osteosynthesis was indicated. By
distracting the leg the integrity of the cartilage could be controlled by
arthroscopy of the hip joint.
Results: Intraoperative all tumours could be reached by the described
approach and a complete curettage without collateral damage could be carried out. In
all 6 cases at 1 year follow-up a complete recovery of the bony situation could be
observed. No tumour recurrence was observed. In none of the cases a revision surgery
was necessary.
Conclusions: The AAMOA seems to be a save option for the treatment of
tumours of the femoral head and neck with a difficult reachability. Due to the
necessity of capsulotomy it is a method only for benign tumours. The possibility of
arthroscopy of the hip joint is a further advantage, especially to control the
integrity of the cartilage.
OP13-416 RESULTS OF HIP ARTHROSCOPY IN PATIENTS WITH MRI DIAGNOSIS OF
SUBCHONDRAL CYSTS - A CASE SERIES
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: This study examines outcomes of hip arthroscopy
patients with labral pathology who have pre-operative MRIs demonstrating
sub-chondral cysts.
Methods: This institution's database was searched for hip arthroscopy
patients that had sub-chondral cysts on MRI and minimum 2-year follow-up. Exclusion
criteria included previous hip surgery, Tönnis grade >1, inflammatory arthritis,
Perthes, SCFE, or abductor repair. Patient reported outcome (PRO) scores, collected
pre-operatively, at 3 months, and annually from surgery, were: Visual Analog Score
(VAS), modified-Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip
Outcome Score-Sports Specific Subscale (HOS-SSS). PRO changes were compared to the
minimally clinical important difference (MCID) to quantify improvement.
Results: 69 patients met all inclusion and exclusion criteria, 65 (94%)
of which had at least 2-year follow-up. Improvements in VAS (5.2-2.8), mHHS (64-76),
NAHS (61-80), and HOS-SSS (41-80) all had p<0.001. The average patient
satisfaction was 7.2 at latest follow-up. There was no correlation with Outerbridge
grade III or IV cartilage damage noted during arthroscopy and sub-chondral cysts
noted on MRI. 17 patients required reoperation; of these, 13 required THA and 4
required revision arthroscopy. 36% of patients with femoral cysts required THA. MCID
for mHHS and HOS-SSS were surpassed by 63% and 68%, respectively.
Conclusions: Hip arthroscopies for patients with sub-chondral cysts
present on pre-operative MRI should be approached with caution. The rate of
conversion to hip arthroplasty appears to be higher than that reported in the
literature for hip arthroscopy patients without these cysts. For those who did not
require future surgeries, patients demonstrated significant improvement.
OP13-415 IS THE EVALUATION OF THE ANTERIOR INFERIOR ILIAC SPINE (AIIS) IN
CONVENTIONAL X-RAYS POSSIBLE? ANALYSIS OF CONVENTIONAL X-RAYS AND 3D-CT
RECONSTRUCTIONS
Krüger D1, Windler M2, Perka
CF2, Schröder J2
1CMSC Berlin, Charité Campus Virchow Klinik, Berlin, Germany;
2Charité-Universitätsmedizin Berlin, Centrum für Muskuloskeletale
Chirurgie (CMSC), Berlin, Germany
Introduction/objectives: Pre-Operative evaluation for subspine
impingement still requires 3D-CT reconstructions to classify the AIIS according to
Hetsroni. In some cases hypertrophy of the AIIS can be seen in conventional x-rays.
Our goal was to compare the AIIS morphology in a.p. pelvis x-rays and 3D-CT
reconstructions.
Methods: We evaluated patients with an a.p.-pelvis x-ray and a pelvic CT
during polytrauma management. We included skeletally mature patients with a standard
projection in the a.p.-pelvis. Pelvic fractures, obvious previous operations and
degenerative changes were excluded. The AIIS type in the a.p.-pelvis was graded
according to its projection to the acetabular sourcil and the anterior acetabular
rim in Group A, B and C. The AIIS morphology in the 3D-CT reconstructions was graded
according to Hetsroni into 3 types (I-III). Patient data of the 3 groups were
compared and the AIIS morphology was compared between x-rays and 3D-CT
reconstructions.
Results: 195 data sets met the inclusion criteria. 30 cases were chosen
with a type A, B and C projection of the AIIS. There was no significant difference
in age, sex and the pelvic inclination. Patients with a type A AIIS in conventional
x-rays showed a type I in 14 (16 type II) in the 3D-CT reconstruction. In group B 8
cases presented a type I (22 type II). Patients with a type C were classified type
III in 28 cases (2 type II).
Conclusions: Accurate differentiation of the AIIS in the a.p.-pelvis is
not possible, especially regarding Hetsroni types I and II. A projection of the AIIS
inferior to the anterior acetabular rim in the a.p.-pelvis shows a high accordance
to a Hetsroni type III and can show evidence for an AIIS hypertrophy. 3D-CT
reconstructions remain essential for a distinct evaluation of the AIIS
morphology.
OP13-62 WHICH IS THE MOST USEFUL PATIENT BASED MEASUREMENT IN FEMOROACETABULAR
IMPINGEMENT?
Introduction/objectives: During the last decade, the patient based
measures (PBMs) have become an important aspect of orthopaedic clinical outcome
evaluation. Performance-based measurement (PBM) methods (such as Timed Walk Tests)
and self-reported questionnaires (SRQ) (such as Modified Harris Hip Score) are
commonly used for evaluating physical function in patient with femoroacetabular
impingement (FAI). The most reliable PBMs for people with FAI are unknown. This
review aims to offer investigators and clinicians a basis for choosing a PBMs method
for clinical practice or for a study.
Methods: We used a defined search strategy in Pubmed database to
identify articles about FAI and assessment. PBM and SRQ, which uses in FAI
assessment were evaluated for the psychometric properties (PP) (Content validity,
internal consistency, construct validity, floor and ceiling effect, test-retest
reliability, intertest reliability, agreement, responsiveness,
interpretability).
Results: This review examined 395 studies, in which 32 different SRQ and
7 PBM instruments were administered to patients with FAI. The present study shows
that Modified Harris Hip Score, Hip Outcome Score, Hip Disability and Osteoarthritis
Outcome Score, International Hip Outcome Tool and Copenhagen Hip and Groin Outcome
Score have adequate PP when assessing patients with FAI. However, 7 PBM don't have
enough PP.
Conclusions: Psychometric properties of PBMs should only be related to
the specific target population and the context in which it has been applied. Based
on the results of our present study, we recommend that the questionnaires and
functional performance-based measurements which have no adequate psychometric
properties are required to assess measurement properties such as validity,
responsiveness and meaningful change in people with FAI.
OP13-430 THE RELATIONSHIP BETWEEN ARTHROSCOPICALLY DEFINED ACETABULAR
CARTILAGE DEFECTS AND PRE-OPERATIVE dGEMRIC INDICES: REFINING THE USE OF
dGEMRIC
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: dGEMRIC is an advanced imaging technique that
may detect early chondral damage. The objectives of this study were to report
associations between dGEMRIC indices and intraoperatively defined acetabular
chondropathy, and to evaluate a new technique for measuring indices to improve
utility in predicting chondropathy.
Methods: Between 2010 and 2015, 195 hips (183 patients) underwent hip
arthroscopy after undergoing dGEMRIC. Exclusion criteria were as follows: previous
hip conditions, Tönnis >1, previous hip surgeries, greater than 180 days between
MRI and surgery, and unreported sagittal superior dGEMRIC index. Indices were
measured using three established and our new method. Indices were correlated to
intraoperative chondropathy (ALAD and Outerbridge) and compared between hips with
no/mild (grades 0 and 1) and those with moderate/severe chondropathy (grades 2, 3,
and 4).
Results: The three established dGEMRIC index measurement methods,
including sagittal superior (SS), coronal superior (CS), and sagittal anterosuperior
(SA), were not significantly different when comparing no/mild to moderate/severe
chondropathy. These indices demonstrated weak correlations to ALAD and Outerbridge.
CAL indices were significantly different between no/mild and moderate/severe
chondropathy (p<0.0001). The CAL index was moderately correlated to ALAD (rho =
−0.403) and Outerbridge (rho = −0.454) grades (p<0.0001).
Conclusions: SS, CS, and SA indices were unable to accurately predict
intraoperative acetabular chondropathy. CAL indices were able to differentiate
between non/mild and moderate/severe chondropathy, and were moderately correlated
with these findings. We propose that the CAL index be added to dGEMRIC protocols to
aid in pre-operatives assessing chondropathy.
OP14 PROM's
OP14-360 WHICH IS THE MOST USEFUL PATIENT BASED MEASUREMENT IN TOTAL HIP
REPLACEMENT?
Nalbant A1, Unver B2
1Sifa University, Izmir, Turkey; 2Dokuz Eylül University,
Izmir, Turkey
Introduction/objectives: It is undeniable that patient based measures
(PBMs) after total hip replacement (THR) are continuously reviewed and monitored, to
improve practice and optimize outcomes after THR. There are various methods to
assess physical function short and simple self-reported questionnaires (SRQ) (such
as Harris Hip Score) and performance-based measurement (PBM) methods (such as Timed
Walk Tests). The most reliable PBMs for people with THR are unknown. The aim of this
study is to offer investigators and clinicians a basis for choosing a PBMs method
for clinical practice or for a study.
Methods: A Pubmed search was performed using terms ‘total hip
arthroplasty’, ‘total hip replacement’ ‘outcomes’ and ‘assessment’. PBM and SRQ,
which uses in THR assessment were evaluated for the psychometric properties (Content
validity, internal consistency, construct validity, floor and ceiling effect,
test-retest reliability, inter-test reliability, agreement, responsiveness,
interpretability).
Results: This review examined 3568 studies, in which 54 different SRQ
and 20 PBM instruments were administered to patients with THR. Based on our
analysis, Harris Hip Score Questionnaire and Hip Dysfunction and Osteoarthritis
Outcome Score have adequate psychometric properties when assessing patients with
THR. However, 20 PBM don't have enough psychometric properties.
Conclusions: The ideal PBMs should be one that is specific target
population the context in which it has been applied. Based on the results of our
present study, we recommend that the questionnaires and functional performance-based
measurements which have no adequate psychometric properties are required to assess
measurement properties such as validity, responsiveness and meaningful change in
people with THR.
OP14-370 RELATIONSHIPS BETWEEN PERFORMANCE-BASED TESTS AND PATIENT-BASED
OUTCOME MEASURES IN PATIENTS WITH TOTAL HIP ARTHROPLASTY
Yuksel E, Cekmece S, Kalkan S, Unver B, Karatosun
V
Dokuz Eylül University, Izmir, Turkey
Introduction/objectives: Various validated outcome tools have been
developed to allow investigators to quantify pre-operative to postoperative
improvements in patients with total hip arthroplasty (THA). These tools include
those that are patient-based outcome measures such as Harris Hip Score (HHS), Berg
Balance Scale (BBS) and performance-based tests such as Timed Up and Go test (TUG),
Single Leg Stance Test (SLST), 10 Meter Walk Test (10-MWT) and 2 Minute Walk Test
(2MWT).
The aim of this study was to investigate correlation between performance-based tests
and patient-based outcome measures in patients with THA.
Methods: Eighteen patients with THA were recruited. The patients
completed 4 performance-based tests (TUG, SLST, 10-MWT and 2MWT). HHS and BBS were
used for outcomes assessment. Correlation analyses were conducted to examine the
relationships.
Results: There were strong correlation between HHS and TUG (r = −0.560,
p = 0.020), 10-MWT (r = −0.649, p = 0.005) and 2MWT (r = −0.627, p = 0.007). There
were strong correlation between BBS and TUG (r = −0.746, p = 0.001), 10-MWT (r =
−0.743, p = 0.001) and 2MWT (r = −0.628, p = 0.007). However, SLST has no
significant correlation between HHS and BBS (p>0.05).
Conclusions: This study shows that performance-based tests and
patient-based outcome measures in patients with THA were inter-related. TUG, 10-MWT
and 2MWT were able to reflect the patient-based outcome measures in patients with
THA. Although patient-based outcome measures may be more appropriate for symptoms,
the patient-based outcome measures may be more appropriate to assess functional
changes. We therefore recommend investigators should use both of these three
performance tests and two patient-based outcome measures to quantify pre-operative
to postoperative improvements in patients with THA.
OP14-395 ARE HEALTH QUALITY SURVEYS USEFUL TO MEASURE THE PATIENTS ANXIETY AND
DEPRESSION
Çekmece S1, Yüksel E2, ünver
B3, Karatosun V
19 Eylul University, 1 School of Physical Therapy and Rehabilitation,
Izmir, Turkey; 29 Eylul University, School of Physical Therapy and
Rehabilitation, Izmir, Turkey; 39 Eylul University, School of Physical
Therapy and Rehabilitation, Izmir, Turkey; 49 Eylul University,
Department of Orthopaedics, Faculty of Medicine, Izmir, Turkey
Introduction/objectives: Numerous studies have reported that
psychological factors can influence outcomes of total hip arthroplasty (THA).
Furthermore, many studies showed that patients with a pre-operative lower mental
health score were more often dissatisfied with the results after THA. Short-Form
Health Survey (SF-12) mental component (MC) and EQ5-D anxiety/depression were
frequently used to determine psychological factors in patients with THA. The purpose
of this study was to investigate the correlation between hospital anxiety and
depression scale (HADS) and anxiety and depression component of EQ5-D and mental
component of SF-12.
Methods: 81 patients with 28 coxarthrosis and 53 hip fractures (51
female, 30 male) were recruited in the current study. The mean age was 67.8 ± 19.2
years. The following parameters were assessed before operation and at discharge to
investigate the correlation between HAD, and SF-12 and EQ5D.
Results: Moderate correlation was found between pre-operative and
postoperative HADS anxiety and depression and EQ5D; pre-operative (r = 0.548 and r =
0.442, respectively) postoperative (r = 0.624 and r = 0.644, respectively). Poor
correlation was found between pre-operative and postoperative HADS anxiety and
depression and SF-12 MC pre-operative (r = −0.404 and r = −0.318, respectively)
postoperative (r = −0.374 and r = −0.436, respectively).
Conclusions: HAD is a golden standard for mental status measurement in
hospital stay as well as widely used SF-12 and EQ5D. SF-12 MC and EQ5D can be used
to evaluate anxiety and depression in patients with THA before and after the
surgery. Anxiety and depression component of EQ5D have better correlation than
SF-12. Thus, we recommend the use of EQ5D in the assessment of anxiety and
depression in patients with THA.
OP14-392 DOES PRE-OPERATIVE ANXIETY AND DEPRESSION REDUCE THE POSTOPERATIVE
FUNCTIONAL LEVEL IN PATIENTS WITH HIP ARTHROPLASTY DUE TO HIP FRACTURE?
Çekmece S1, ünver B2, Karatosun
V3
19 Eylul University, 1 School of Physical Therapy and Rehabilitation,
Izmir, Turkey; 29 Eylul University, School of Physical Therapy and
Rehabilitation, Izmir, Turkey; 39 Eylul University, Department of
Orthopaedics, Faculty of Medicine, Izmir, Turkey
Introduction/objectives: Hip fracture is the most serious fall-related
cause of morbidity in elderly persons. Despite good surgical outcomes, studies have
found that functional outcomes after hip fracture are variable, with only one-half
of patients able to return to the community after a fracture and as few as one-third
of patients able to regain their pre-fracture level of physical functioning.
Moreover, several studies have found that depressive symptoms and cognitive
impairment are common in hip fracture patients. This study examines the effects of
depression in elderly hip fracture patients receiving inpatient rehabilitation. Our
aim was to determine whether there is any association of depression with post op
rehabilitation outcome.
Methods: We assessed depression and anxiety level before surgery using
the Hospital depression and anxiety scale (HAD) and rehabilitation outcomes using
Iowa Level of Assistance Scale when discharge in this prospective observational
study of 50 patients with hip fracture.
Results: The mean age of patients was 76.6 years. There was a
significant correlation between pre-operational HAD scores and discharge IOWA scores
(r = −548, p<0,001). The multiple regression analysis revealed that pre HAD score
was significant and independent predictor of the post op iowa, accounted for 24% of
the variance.
Conclusions: This study has indicated that pre-operative anxiety level
predicted poorer rehabilitation outcome in elderly hip fracture patients. Patients
with higher anxiety level might not effectively mobilize and participate in their
therapy sessions. Clinicians and researchers should be aware of anxiety level during
pre op period. Methods to reduce anxiety level may lead to better outcomes in
elderly patients with hip arthroplasty due to hip fracture.
OP14-369 ASSESSING MINIMAL DETECTABLE CHANGE AND RELIABILITY OF BALANCE TESTS
IN PATIENTS WITH TOTAL HIP ARTHROPLASTY
Unver B, Yuksel E, Kalkan S, Cekmece S, Karatosun
V
Dokuz Eylül University, Izmir, Turkey
Introduction/objectives: In a recent review, it is suggested that
balance may be assessed by measuring the time needed to complete specific gait and
balance tasks such as Timed Up and Go Test (TUG), Single Limb Stance (SLS),
Functional Reach Test (FRT), 10 Meter Walk Test (10-MWT) and Five Times Sit to Stand
Time (5TSTS).
The aim of this study was to investigate the minimal detectable change at the 95%
confidence level (MDC95) and the test-retest reliability of the five balance tests
in patients with THA.
Methods: Eighteen patients with THA were recruited. Patients performed
two trials for all five tests on the same day. Between the first test and the
second, patients were provided rest breaks as needed throughout the testing session.
During this period, patients were not allowed to drink or eat anything.
Results: The TUG, 5TSTS, FRT, and 10-MWT were shown to have excellent
reliability and the SLS was shown to have moderate reliability. The ICCs for the
TUG, 5TSTS, FRT, 10-MWT and SLS were 0.91, 0.85, 0.84, 0.89 and 0.62, respectively.
The SEMs for the TUG, 5TSTS, 10-MWT and SLS were 0.48, 0.50, 0.43 and 6.78 seconds,
respectively. The SEM for the FRT was 2.88 mm. The MDC95s for the TUG, 5TSTS, 10-MWT
and SLS were 1.33, 1.39, 1.19 and 18.79 seconds, respectively. The MDC95 for the FRT
was 7.98 mm.
Conclusions: This is the first study that investigated the MDC and
reliability of the balance tests in patients with THA. The four of these balance
tests (TUG, 5TSTS, FRT, and 10-MWT) have excellent test-retest reliability.
Clinicians and researchers can also use these MDC values to make accurate statements
about the amount of change observed over time. We therefore recommend the use of
these four tests as complementary outcome measures for balance assessment in
patients with THA.
OP14-329 RELIABILITY OF TEN STEP AGILITY TEST IN PATIENTS WITH HIP
ARTHROPLASTY
Çekmece S1, Yüksel E2, ünver
B3, Karatosun V4
19 Eylul University, 1 School of Physical Therapy and Rehabilitation,
Izmir, Turkey; 29 Eylul University, School of Physical Therapy and
Rehabilitation, Izmir, Turkey; 39 Eylul University, School of Physical
Therapy and Rehabilitation, Izmir, Turkey; 49 Eylul University,
Department of Orthopaedics, Faculty of Medicine, Izmir, Turkey
Introduction/objectives: Evaluation of outcomes following total hip
arthroplasty (THA) is important. Using objective assessment methods is essential to
clinicians for determining both the prognosis and the healing of patients after THA.
Not only the reduction of muscle strength or balance, but also the reduction of the
agility are regarded as important factors of falls in THA patients. To predict the
risk of fall, complex motor function should be evaluated. A new test, focused on
agility, will allow us to design exercises tailored to individual motor
function.
The aim was to investigate the test-retest reliability of 10-step agility in patients
with THA.
Methods: We recruited nineteen patients with THA (9 female, 10 male).
Patients performed twice trials for 10-step agility on same day. Between the first
and second trials, patients waited for an hour on sitting position in order to
prevent fatigue. To assess reliability, intra-class coefficient [ICC (2,1)],
standard error of measurement (SEM) smallest real difference at the 95% confidence
level (SRD95) were calculated.
Results: The average time for the first trial was 8,16 ± 1,08 seconds
and 7,82 ± 1,21 seconds for the second trial. There was no significant difference
between the trials (p>0.05). ICC, SEM and SRD95 for ten step agility were 0.94,
0.26 and 0,74 respectively.
Conclusions: Reliability of ten step agility test is excellent for
patients with THA. These tests are simple, no time consuming and sensitive methods
to measure the functional performance and also can be used to quantify even small
changes in functional performance in patients with THA in the clinical setting.
OP14-253 DOES PRE-OPERATIVE PATIENT-REPORTED HEALTH STATUS DETERMINE MORTALITY
AFTER TOTAL HIP REPLACEMENT?
1Swedish Hip Arthroplasty Register, Department of Orthopaedics, Institute
of Clinical Sciences, Gothenburg, Sweden; 2SHAR, Gothenburg, Sweden;
3SHAR, PEOC, Exeter, UK, Gothenburg, Sweden; 4SHAR,
Institute for Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden;
5Department of LIME, Medical Management Centre, Stockholm, Sweden
Introduction/objectives: The risk of dying following total hip
replacement (THR) is low and has declined over the last decades. As co-morbidities
and physical status influence mortality, it leads us to believe that
patient-reported health status may also be a predictor of mortality. Although this
has not been demonstrated in THR surgery some studies in other fields have reported
an association. We investigated the relationship between patient-reported health
status before total hip replacement and the risk of dying up to 5 years
postoperatively.
Methods: Using a linked database of the Swedish Hip Arthroplasty
Register and Statistics Sweden we studied the relationship between the pre-operative
gathered patient reported health status (EQ-5D and pain VAS) and mortality. 42862
patients who underwent a first THR between 2008 and 2012 with a diagnosis of primary
osteoarthritis and a full data set were identified and studied. Survival data were
analysed and illustrated using relative survival curves, multivariable modelling
proceeded by time-transformed Cox proportional hazards.
Results: As a group THR patients had a better 5-year survival than the
general population. Overall results show increased survival of patients reporting no
versus moderate versus extreme problems for all EQ-5D dimensions. Broken down by the
five EQ-5D dimensions we observed different survival patterns depending on the
level. The effect was more obvious in patients reporting different levels of
self-care and mobility. Hazard ratios did not differ significantly in the pain
dimension. Hip pain (VAS) did not influence mortality.
Conclusions: Worse self-reported health status using EQ-5D is associated
with higher mortality up to 5 years after surgery. EQ-5D may be useful in
pre-operative individual risk assessment.
OP14-133 THE EFFECT OF PATIENT EDUCATION ON LENGTH OF STAY USING VALUE-BASED
DISCHARGE CRITERIA
Meermans G, Van Doorn J, Kats J-J
Bravis Hospital, Bergen op Zoom, The Netherlands
Introduction/objectives: During the last decade, there has been
increased interest in fast-track surgery using optimal multimodal perioperative care
to enhance recovery after total hip arthroplasty (THA). The goal of this prospective
study was to study the effect of patient education and the use of clear, functional
discharge criteria on LOS after primary THA.
Methods: Between February 2012 and June 2015, 400 consecutive patients
who underwent primary THA were included in this prospective comparative study. The
discharge criteria were: able to mobilize independently with crutches, a dry wound,
and pain controlled on oral medication. In the first 200 patients, patients were
informed that LOS after THA was expected to be 4 days as was the standard of care in
our practice at that time. In the second 200 patients, intended LOS was told to be 2
days.
Results: The mean LOS was significantly shorter in the second group (2.8
versus 3.3 days respectively, p = 0.0016). LOS was significantly lower when
excluding patients that had to wait for transfer to a rehabilitation ward (3.1
versus 2.7 days, p = 0.0004), but the difference between both groups remained
significant (2.5 versus 3.0 days, p<0.0001). In the second group, 61% of the
patients were discharged at day 2 and 81.5% at day 3 postoperatively versus 27% and
66.5% in the first group (p<0.0001 and p = 0.0009 respectively).
Conclusions: THA has historically been associated with a relative long
LOS. Our study highlights the importance of clearly informing the patients about the
intended LOS in combination with functional discharge criteria. This information has
to be uniform and expressed by surgical, nursing and physiotherapy staff. These data
also demonstrate the possibility of observer-expectancy effect when using LOS as an
endpoint.
OP14-391 INVESTIGATION OF RELATIONSHIP BETWEEN PRE-OPERATIVE GRIP STRENGTH
MEASUREMENT AND DURATION OF HOSPITAL STAY IN PATIENTS WITH TOTAL HIP
ARTHROPLASTY
Çekmece S1, ünver B1, Karatosun
V2, Günal IH2
19 Eylul University, 1 School of Physical Therapy and Rehabilitation,
Izmir, Turkey; 29 Eylul University, Department of Orthopaedics, Faculty
of Medicine, Izmir, Turkey
Introduction/objectives: Grip strength has been reported to be
predictive of disability and mortality, as well as a surrogate measurement of
overall muscle strength. Negative relationship has been reported between grip
strength and multi-morbidity, as measured by the number of diseases.
Our objective was to investigate the relationship between pre-operative hand grip
strength and the length of hospital stay in patients undergoing hip
arthroplasty.
Methods: 35 patients (14 male, 21 female) due to undergo hip
arthroplasty were recruited. Average measurements of hand grip preoperation were
taken from each patient using the Jamar hydraulic dynamometer. Normative static hand
grip strength was 45.2 ± 7.6 for males, and 25 ± 4.1 for females and we used those
data for group separation in Turkey.
Results: There were no significant differences between the duration of
length of hospital stay and hand grip strength (p = 0.273, p>0.05). There was a
poor correlation between length of hospital stay and hand grip strength (r =
−0.219). However, the mean hospital stay for patients below normative value was 8,5
± 4,7 days and hospital stay for patients above normative values were 6,8 ± 2,4
days. There were two days differences in terms of the length of hospital stay
between two groups.
Conclusions: Although there were no statistically significant
differences, patients who have weaker hand grip strength, stay longer time in
hospital compared to patients who have stronger hand grip strength. Assessment of
pre-operative grip strength, may lead efficient usage of hospital resources and
rehabilitation facilities.
OP14-261 SAME DAY MOBILISATION FOLLOWING TOTAL HIP ARTHROPLASTY IMPROVES
OUTCOME IN ENHANCED RECOVERY PROGRAMMES Haggis P,
Popat R, Buddhdev P, Holloway I
Northwick Park Hospital, Orthopaedics Department, London, UK
Introduction/objectives: The introduction of enhanced recovery
programmes (ERP) for lower limb arthroplasty have been shown to increase patient
satisfaction and decrease costs, complications and length of hospital stay.
Post-operative inpatient rehabilitation is a critical component of the physiotherapy
program and focuses on early mobilisation.
We aim to determine the importance of Day 0 physiotherapy on length of hospital stay,
and whether the level of achievement can predict earlier discharge. The secondary
aim is to assess whether pain score had an effect on physiotherapy achievement.
Methods: We collected prospective data for all patients undergoing the
same ERP for THA in our hospital for a calendar year, with 164 patients matched for
age, sex, and anaesthetic type. 72 patients had their first physiotherapy on Day 0,
with 92 on Day 1. We recorded their physiotherapy achievements and pain scores.
Results: There was no significant difference between the length of stay
of the two groups when compared directly, though there is a difference on both the
mean and the median stay (Day 0 Mean 3.82 Median 3, Day 1 5,4, p = 0.078), however,
when the Day 0 group was divided into physiotherapy achievement, higher achievement
predicted earlier discharge, with the walkers staying a mean of 3.19 days, median of
3, p = 0.016. There was no significant difference in pain scores of the Day 0
sub-groups (p = 0.28).
Conclusions: There are clear benefits to post-operative physiotherapy,
and we have shown that early physiotherapy can have benefits in reducing the length
of stay of patients who manage to walk on the day of their surgery. The ability to
walk on Day 0 is not related to pain score.
We have also shown that there is no significant negative effect of delaying first
physiotherapy to Day 1.
OP14-324 PATIENT EXPERIENCE IN DAY CARE TOTAL HIP ARTHROPLASTY USING A
STANDARD POSTERIOR APPROACH
Boevé M, Bolder S, van den Hout J, Koenraadt K, van
Geenen R
Amphia Hospital, Breda, The Netherlands
Introduction/objectives: Multimodal anaesthesia techniques and rapid
rehabilitation can facilitate early discharge after THA. Outpatient surgery (OS)
protocols have been introduced for THA and are feasible, safe and cost-effective.
However, the patients' perspective is relatively unknown. We investigated our early
experience on how patients experience OS for hip arthroplasty with a standard
posterior approach.
Methods: This case-control study presents data on 18 patients undergoing
THA; half of the patients in an OS setting and the other half following a standard
procedure with Rapid Recovery aftercare protocol. Psychological distress was
measured with the Hospital Anxiety and Depression Scale (HADS). Pain and
satisfaction, but also feeling of safety and anxiety were scored with a numeric
rating scale (NRS, 0-10) and we determined a Net Promoter Score (NPS).
Questionnaires were performed on postoperative day 0, 1, 2 and 7. After one week, we
asked if the treatment had met the patients' expectation. NRS and HADS scores were
compared with a t-test, chi-square test was used for nominal variables.
Results: Both groups regarded their treatment as safe and had low
anxiety scores. We did not find any statistically significant differences in NRS or
HADS at all time points. Pain scores and satisfaction also did not statistically
differ between the groups. The NPS was higher in the OS group (33 vs 11), but was
positive in both groups.
Conclusions: In this pathway, THA in a day care setting using a standard
posterior approach can be safely introduced. We found no differences with our normal
fast track recovery pathway with regard to pain and satisfaction and the patients'
experience using multiple safety and anxiety scores. The number of promoters in a
NPS was even higher in the OS group.
OP15 Conservative hip surgery
OP15-347 MORE THAN HALF OF THE PATIENTS ELIGIBLE FOR JOINT PRESERVING HIP
SURGERY PRESENT WITH A PATHOLOGICAL FEMORAL TORSION
Lerch T, Todorski I, Steppacher S, Schmaranzer F,
Siebenrock K, Tannast M
Inselspital Universitätsspital, Bern, Switzerland
Introduction/objectives: Femoral maltorsion can amplify or antagonize
femoroacetabular impingement (FAI) or hip instability. It is unknown how often
torsional deformities are present in young patients with hip pain eligible for joint
preserving surgery.
We therefore questioned (1) what is the prevalence of femoral maltorsion in
symptomatic hips eligible for hip preserving surgery; (2) which hip
pathomorphologies are associated with maltorsion; (3) what is the prevalence of
combined abnormalities of acetabular and femoral version? Methods: We
retrospectively compared femoral torsion and acetabular version among ten subgroups
with hip pathomorphologies and a control group. A total of 462 patients (538 hips)
were included between January 2011 and December 2015. The subgroups comprised:
dysplasia, overcoverage, severe overcoverage, retroversion, anteversion, cam, mixed
FAI, varus, valgus and Perthes hips. Femoral torsion and acetabular version were
measured on CT/MRI scans. Maltorsion was defined as <10° or >25° of femoral
torsion and severe maltorsion as <0° and >35°.
Results: (1) Fifty-two percent of hips presented with femoral
maltorsion. Severe maltorsion was present in 17% and increased compared to the
normal group with 0% (p<0.001). (2) An excessive femoral torsion was present in
dysplasia, valgus and Perthes subgroups. (3) 69% of the hips presented with an
abnormal combination of femoral torsion and acetabular version. The most frequent
pathological combination was an increased femoral torsion/normal acetabular version
with a prevalence of 22%.
Conclusions: Torsional abnormalities of the femur are very commonly
present in hips that are eligible for joint preserving surgery. The evaluation of
young patients with hip pain should always include an assessment of femoral
torsion.
OP15-336 LABRAL REPAIR RESTORE NORMAL BIOMECHANICS OF THE HIP
Tey M1, Leon A2, Marques
F2, Reina de la Torre F3, Monllau
JC1
1Hospital del Mar, Hospital Dexeus, Barcelona, Spain; 2Hospital
del Mar, Barcelona, Spain; 3Univeristat de Girona, Girona, Spain
Introduction/objectives: Acetabular labral seal is essential to maintain
normal biomechanics of the hip joint. Normal biomechanics of the hip protects
against increased stress load of the cartilage. Articular increased stress load
leads to osteoarthritis.
The main objective of the present study is evaluation of articular peak stress with
healthy acetabular labrum, after tear of it and after repair of the labrum. Other
objectives are study of abnormal biomechanics with small or large labrum tears.
Methods: In vitro study with five cadaveric specimens mounted in a test
bench. Study of peak stress with an intra-articular dynamic pressure sensor
(Tekscan(R)) in maximum flexion, extension, internal rotation and external rotation
movements. T test study for paired data in three different situations: healthy
labrum against partial tear, healthy labrum against repaired labrum, partial tear
against complete tear of the labrum. Significance was defined at p = 0.001.
Results: Articular peak stress increased with partial labral tear.
Articular peak stress normalized with labral repair. Articular peak stress was
similar between partial or complete tear.
Conclusions: Labral tear change normal biomechanics of the hip with an
increase of peak stress.
The abnormal biomechanics of the hip in terms of increased articular peak stress is
independent of labral tear size. Labral repair restore biomechanics of the hip.
OP15-377 MIDTERM FOLLOW-UP OF PATIENTS WITH PERIACETABULAR OSTEOTOMY WITH AND
WITHOUT SIMULTANEOUSLY TREATED CAM DEFORMITY
1Universitäts Centrum für Orthopädie und Unfallchirurgie,
Universitätsklinikum Carl Gustav Carus, Dresden, Germany;
2Universitätsklinikum Carl-Gustav-Carus, Klinik und Poliklinik für
Orthopädie, Dresden, Germany
Case Study: Periacetabular osteotomy (PAO) is a well-established
procedure for the treatment of hip dysplasia. Recent retrospective follow-up
examinations have shown that concomitant femoral cam deformity is a predictor for
worse outcome if not treated appropriately. We have established a treatment
algorithm performing PAO and simultaneous correction of cam deformities as well as
associated intraarticular pathology.
106 PAO were performed at our institution between 07/2005-12/2010. After a mean
follow-up time of 64 months, 85 PAO could be re-examined. All patients underwent
clinical examination (including assessment of WOMAC, OHS, GTO) as well as X-ray and
hip MRI. Statistical analysis was performed using SPSS (U-Test, ANOVA).
The postoperative WOMAC-score increased significantly in comparison to pre-operative
values (91 ± 14vs.73 ± 18, p<0,001). The CE angle improved from 15 ± 6° to 32 ±
7° (p<0.001). Together with PAO a femoral offset correction was performed in
57.6% of the cases. Prior to intervention the mean alpha angle was 50 ± 13.6° for
cases without and 55.8 ± 14.9° for cases with correction. After intervention the
mean alpha angle was 46.7 ± 11.4° for cases without correction and 38.2 ± 5.8° for
cases with femoral neck offset correction. Evaluating both groups, there was no
significant difference regarding clinical scores. The conversion rate to hip
arthroplasty or progression of osteoarthritis was not significantly different in
both groups.
Patients with additional neck trimming had no worse outcome than patients without cam
deformity and isolated PAO in our study. This finding highlights the importance of
pre-operative deformity assessment and intraoperative selection of appropriate
surgical technique.
OP15-400 THE IMPLANTATION OF A HEMICAP FOR TREATMENT OF LOCAL CARTILAGE
LESIONS OF THE FEMORAL HEAD - FIRST RESULTS
Flörkemeier T, Budde S, Gronewold J, Windhagen H, von
Lewinski G, Ezechieli M
Introduction/objectives: Local cartilage lesions are difficult to treat.
In these cases the lesion is often limited to the femoral head and the patient is
young without severe sign of osteoarthritis. The implantation of a total hip
arthroplasty seems to be overkill. However, joint preserving techniques do no show
satisfying results. The implantation of a hemicap (2 med, Hamburg, Germany) is a
possible alternative treatment for these patients. It is an arthrosurface system
that fills the defect and restores a smooth and continuous articular surface. The
aim of this study was to determine short- to midterm results of the treatment of
local cartilage defects of the femoral head using the so called Hemicap.
Methods: Over the last years 18 patients with ONFH ARCO stage III or IV
or local femoral cartilage lesions were treated with the implantation of a so called
Hemicap. Initially the implantation was conducted using an open hip dislocation
according to Ganz with a trochanter-flip-osteotomy. With increasing experience an
implantation was possible via an open dislocation of the hip using the direct
anterior approach. A clinical and radiological follow-up was conducted using the
Harris-Hip-Score and the UCLA-activity score.
Results: The clinical results revealed a significant improvement of the
function and pain of the hip. In the meantime in five patients the hemicap had to be
converted to a total hip arthroplasty. Reasons for these failures were loosening,
progredience of the osteonecrosis or degeneration of the acetabulum.
Conclusions: The implantation of the arthrosurface Hemicap is an
alternative treatment for local cartilage defects of the femoral head. It can delay
the implantation of a total hip arthroplasty. However, it is important to choose the
proper patient for this treatment (limited size of the defect, only femoral
cartilage defect, no degeneration of the acetabulum).
OP15-192 CHANGES IN PERIACETABULAR BONE MINERAL DENSITY FIVE YEARS AFTER
RESURFACING HIP ARTHROPLASTY VERSUS CONVENTIONAL TOTAL HIP ARTHROPLASTY
Gerhardt D, Smolders J, de Visser E, Roovers L.
Rijnders T, van Susante J Rijnstate Ziekenhuis, Arnhem, The
Netherlands
Introduction/objectives: Bone stock preservation is an important goal in
hip arthroplasty. We studied whether acetabular bone mineral density (BMD) is better
preserved after resurfacing hip arthroplasty (RHA) versus small diameter metal-on-
metal total hip arthroplasty (MoM THA).
Methods: In this five year randomized trial a total of 73 patients were
included for BMD follow up. Acetabular BMD was measured in five periprosthetic
regions of interests (ROI) with dual-energy absorptiometry (DEXA) pre-operatively,
at three and six months, one, two, three and five years postoperatively. A total of
35 RHA and 28 THA had a complete five years follow-up. Eight patients were lost to
follow up (3 RHA, 5 THA). One RHA and 1 THA were revised due to pseudotumour
formation, 2 THA were revised because of recurrent dislocations and 1 RHA for
avascular necrosis.
Results: Overall an initial decrease in BMD was observed for both
implants with stabilizing levels after two years. Five years after RHA a BMD
decrease of −1%, 4% (p<0.01), 8% (p<01), 7% (p<0.01) and −4% compared to
baseline values was seen in the upper cranial, cranial, craniomedial, medial and
caudal ROI respectively. Five years after THA a similar trend, however with more BMD
decrease, was encountered with 3%, 13% (p<0.01), 21% (p<0.01), 11%
(p<0.01)% and 2% for each respective ROI. The trend in BMD decrease in different
ROI was structurally favouring RHA throughout follow-up, with significantly higher
levels in the cranial and craniomedial ROI (p<0.01).
Conclusions: This study provides a high level of evidence that
acetabular BMD is better preserved after RHA with a rigid press-fit cup compared to
conventional THA with a titanium threaded cup particularly in the cranial and
craniomedial ROI.
OP15-200 THE FATE OF THE NECK WITH THE COLLUM FEMORIS PRESERVING (CFP)
PROSTHESIS. A 19-YEARS SINGLE CENTER EXPERIENCE
1IRCCS Ospedale San Martino-IST, Genova, Italy; 2Clinica
Montallegro, Genova, Italy
Introduction/objectives: The aim of our study is to evaluate long term
results of CFP stem correlating neck resorption with comorbidities, clinical
outcomes and complications.
Methods: This is a retrospective study on 176 patients (194 hips). The
mean follow-up (f.u.) was 14.2y ± 2.1. Demographic features and surgical data were
collected. Clinical evaluation (HHS, VAS, OHS, thigh pain and LLD) and radiological
investigation were performed at the last f.u. We calculate a Neck Resorption Ratio
(NRR). Complications were recorded. For statistical analyses, a p-value of <0.05
was considered significant. Fisher test, Bravais-Pearson correlation coefficient and
Odds Ratio (OR) calculation were also employed.
Results: HHS was 89.1 ± 5.7; VAS was 1,1 ± 1 and OHS was 41.3 ± 5.1. 7
patients complained thigh pain. LLD was 1.5 mm ± 1.9. 32 cases of osteolysis and 19
of cortical hypertrophy were observed. Mean NRR was 0.35. We observed 6 cases of
Aseptic Loosening (AL), 2 cases of PJI, 1 implant revision for recurrent dislocation
and 1 stem revision after periprosthetic femoral fracture. The overall stem survival
rate was 94.8%. Associations between NRR and steroid therapy/varus/valgus stem were
significant. Correlation between AL and NRR was significant for p<0.05.
Correlations between NRR and HHS/OHS were - 0.34 and −0.28 respectively. OR for AL
were: 4.6 for a NRR >0.25; 16.9 if >0.50 and 24.1 if >0.75.
Conclusions: CFP hip stem provide excellent/good long-term outcomes. NRR
is correlated to steroid therapy. Clinical outcomes and stem AL are linked to NRR.
The risk of stem AL rises according to NRR increase. Patients with a NRR>0,5,
especially if under steroid therapy or with varus/valgus stem, should be strictly
followed for AL.
OP16 Fast Track Surgery
OP16-224 PATIENT POSITIONING AFFECTS ANTEVERSION IN TOTAL HIP
ARTHROPLASTY
1NYU Langone Hospital for Joint Diseases, New York, USA;
2Hospital for Special Surgery, New York, USA
Introduction/objectives: Computer/robotic navigation has been shown to
improve the precision of acetabular component position in THA. The purpose of our
study was to utilize robotic-arm assisted computer navigation to assess the
reliability of pelvic position in total hip arthroplasty, which can directly impact
anteversion and inclination.
Methods: 100 hips underwent a CT-guided robotic THA via a minimally
invasive posterior approach in the lateral position. The surgeon placed the robotic
arm parallel to the longitudinal axis of the patient and the horizontal surface of
the table, representing 0 degrees anteversion and inclination. The software
generated values of this perceived zero-zero position based on the registration of
the patient's pre-operative CT. To ensure the accuracy of measurements, cup
anteversion and inclination at time of impaction were recorded and compared to 3
month postop X-rays.
Results: 22% of anteversion values were altered by >10 degrees and
41% of anteversion values were altered by >5 degrees. Range of anteversion was
−20 to 20 degrees. 2% of inclination values were altered by >10 degrees. 18% of
inclination values were altered by >5 degrees. Anteversion differences were
correlated with patient BMI (p = 0.02).
There was no difference in robotic planned anteversion and inclination compared to
postoperative X-rays (21.8 vs 21.9 degrees anteversion; 40.6 vs 40.5 degrees
inclination).
Conclusions: Pelvic positioning devices offer up to 20 degrees of
variability in acetabular cup orientation. Compounding this with the fact that human
error is prone to 10 degrees of anteversion inaccuracy, it is essential to ensure
accurate patient position or use some form of computer/robotic navigation to place
acetabular components within the well defined safe zones.
OP16-251 THE INFLUENCE OF LOCAL INFILTRATION ANALGESIA BY CATHETER IN
POSTOPERATIVE CONTROL PAIN AFTER TOTAL HIP REPLACEMENT
Fraile Suari A, Cuenca Llavall M, Perez-Prieto D,
León Garcia A, Santiveri Papiol X, Marques Lopez F
Hospital del Mar, Barcelona, Spain
Introduction/objectives: Local infiltration analgesia (LIA) by catheter
infusion has been developed as a new technique to improve pain control and reduce
side effects after total hip replacement (THR).
The main purpose of the present study is to determine if LIA is superior to
conventional analgesia in terms of pain control and side effects after THR.
Methods: A randomized double-blind clinical trial was performed. There
were 4 groups according to catheter placement and infusion constituents: 1)
Intraarticular catheter + anaesthetics; 2) Intraarticular catheter + placebo; 3)
Subfascial catheter + anesthetics; 4) Subfascial catheter + placebo. The
anaesthetics infusion contained bupivacaine (bolus + continuous perfusion up to 36
hours). The placebo solution consisted in physiological serum (bolus + continuous
perfusion up to 36 hours). The same conventional analgesic schedule was prescribed
to all patients. The pain was evaluated by means of PCA shots and the VAS. Side
effects, time to start rehabilitation and time to discharge were also analysed. A
statistical analysis was performed.
Results: There were 100 (25 patients in each group). Mean age was 67
years old (SD 12 y/o) and 53% were male. Mean PCA shots were 27 [range 2-87 shots]
and mean VAS was 1 [range 0-7]. Side effects presented in 32.3% of patients which
dizziness (15.6%), sleepiness (7.3%) and nausea (6.3%) were the most frequent.
Rehabilitation started at a mean of 42 hours (SD 11.2 hours) and hospital stay was 5
days (SD 1.1 days). No difference was found (p>0.05) when these variables were
compared between the groups.
Conclusions: The use LIA with bupivacaine using a catheter infusion does
not provide a better pain control after THR. Moreover it has no impact in reducing
side effects, time to start rehabilitation or hospitalization.
OP16-35 MONITORING OF BLOOD PRESSURE DURING TOTAL HIP ARTHROPLASTY USING THE
INTERFACE BIOACTIVE BONE CEMENT TECHNIQUE
Fujita H
Institute for Joint Replacement, Kyoto Katsura Hospital, Kyoto, Japan
Introduction/objectives: The purpose of the present study was to monitor
the blood pressure changes that occur after cementing during primary total hip
arthroplasty (THA).
Methods: The present study examined 178 cases in which 204 joints were
treated with primary THA. Under general anaesthesia, both hip components were
cemented in place using an anterolateral approach. After the cementing, systolic
arterial blood pressure was measured at 1-minute intervals until 5 minutes and then
again at 10 minutes. The maximum regulation ratio (MRR) was calculated as- (maximum
change in blood pressure - blood pressure before cement application) divided by
blood pressure before cement application.
Results: No major complications such as cardiac arrest occurred. In most
cases, blood pressure increased until 4 minutes on the acetabular side and until 2
minutes on the femoral side, and then gradually returned to the level seen before
cement application. On the acetabular side, the mean MRR was 11.2% (SD: 15.9; range:
−26 to 80), whereas it was 6.4% (SD: 14.9; range: −31 to 65) on the femoral side.
Correlations were detected between the MRR classification on the acetabular side and
the subject's age at the time of the operation or bleeding control status on the
acetabular side. When bleeding control was judged as complete, the tendency for
blood pressure to decrease was reduced. Conversely, when bleeding control was judged
as good, blood pressure showed a greater tendency to decrease.
Conclusions: During THA involving the IBBC cementing technique, when
bleeding control on the acetabular side was judged as complete the tendency for
blood pressure to decrease was reduced.
OP16-236 INTERMITTENT PNEUMATIC COMPRESSION FOR VENOUS THROMBOEMBOLISM
PROPHYLAXIS AFTER TOTAL HIP ARTHROPLASTY IN GERMANY
Saunders R1, Mittard V2,
Sullivan M2
1Coreva Scientific GmbH & Co KG, Freiburg im Breisgau, Germany;
2Medtronic, Whiteley, UK
Introduction/objectives: Multiple options for venous thromboembolism
(VTE) prophylaxis after surgery exist, but there is little use of intermittent
pneumatic compression (IPC) in Germany. A computer model was developed to evaluate
how IPC may impact on patient health and cost outcomes after total hip arthroplasty
(THA).
Methods: Markov models for VTE and adverse events assessed expected
incidence of deep-vein thrombosis (DVT), pulmonary embolism (PE) and other key
endpoints. Efficacy and safety of prophylaxis were taken from meta-analyses specific
to orthopaedic surgery where possible. Patient data are from the ORTHO-TEP registry
(mean age 66.9 years; 41.2% male; Dresden, Germany). Incidences of VTE (3.0%) and
bleeding (7.1%) with Low Molecular Weight Heparin are specific to this THA
population. Event costs from peer-reviewed literature were inflated to 2015 Euros.
Sensitivity analyses assessed the robustness of outcomes, with 95% credible
intervals (CrI) calculated from 500 simulations.
Results: In the base case, the 1,000 patients experienced an estimated
34 DVTs, 11 PEs, and 87 major bleeds over 1 year. The total cost to the provider is
estimated at EUR 636, 277, with a cost per patient year of EUR 642. Normalized by
market share, pentasaccharide and unfractionated heparin were the most expensive,
while IPC and coumadin were the least expensive. Increasing IPC market share by 5%
(with 1% taken from each alternative) reduced costs by EUR 9,391 and resulted in
fewer DVTs and PEs, and significant reductions in minor and major (95% CrI
−1.49-0.43 events) bleeding.
Conclusions: IPC is safe and effective and likely to be a cost-effective
option for VTE prophylaxis after THA. Compared with pharmacoprophylaxis, IPC targets
stasis and providers could consider extending its use.
OP16-410 AUDIT OF PERI-OP ANTICOAGULATION PROTOCOL IN PRIMARY HIP AND KNEE
ARTHROPLASTY PATIENTS
Jose Edakalathur J, Panchani S, Gambhir A
Wrightington Hospital, Wigan, UK
Introduction/objectives: There are various guidelines put forward by
various organisations for safe peri-operative anticoagulation. According to nice
guidelines, warfarin is usually stopped 5 days before planned surgery, and once the
person's INR is below 1.5, surgery can go ahead. Warfarin is resumed at the normal
dose on the evening of surgery or the next day if haemostasis adequate.
The aim of the audit was to assess our adherence to the Peri-operative
anticoagulation protocols.
Methods: All Primary Total Hip and Total Knee joint replacement patients
admitted over a period of 6 months from March - August 2015 in Wrightington who were
on Warfarin Pre-operatively were selected for the study.
Along with Demographic data, the reason for start of anticoagulation, time of
stopping of stopping of warfarin pre-op, starting of bridging therapy, dose and time
of restart of warfarin, INR at discharge and Post-op complications related to
anti-coagulation were collected.
Results: 30 patients were eligible to be included of which 21 had low
risk of thrombosis and 9 were high risk. All the low risk patients were given 5
doses of dalteparin instead of the required single dose. None of the high risk
patients were given the appropriate dose of bridging therapy. Only 36.7% had
appropriate dose of warfarin restarted in the post-op period.
One of the patients did not have bridging therapy. All patients had an INR below 1.5
at the time of surgery. Nine patients had complications related to
anticoagulation.
Conclusions: It was concluded that there is a need to increase the
awareness among the surgeons of the NICE guidelines on peri-operative anticoagulant
protocols. The pre-op appointment communication sheet also was to be altered as it
wrongly advised for 5 doses of pre-op anticoagulation instead of one.
OP16-102 USING TRANEXAMIC ACID TO DECREASE POSTOPERATIVE HEMORRHAGE: LOCAL
VERSUS INTRAVENOUS ADMINISTRATION
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Shahid Beheshti University of Medical Sciences, Bone,
Joint and Related Tissue Research Center, Tehran, Islamic Republic of Iran
Introduction/objectives: Postoperative bleeding is one of the most
important problems after major orthopaedic surgeries including Total hip
arthroplasty (THA). It has been demonstrated that Tranexamic acid is a useful agent
to control the volume of blood loss. However, the more effective route of TXA
administration remained controversial. In current study, we compared the effects of
local and intravenous (IV) administration of TXA on need to blood transfusion and
haemoglobin drop.
Methods: There were 80 patients underwent THA assigned to 2 groups,
randomly: local (L) group and IV group. In group IV, 500 mg TXA was administered
systematically and in group IV the joint was irrigated with 4 of TXA in 100 cc of
normal saline. The level of Hb was measured before and 12 hours after the operation
and the rate of Hb drop was compared. Also, the number of packed cell transfused was
compared in two groups.
Results: The mean of Hb drop was 1.7 ± 1.1 mg/dL and 2.5 ± 1.2 mg/dL in
group IV and L, respectively. In group IV, 0.32 ± 0.6 units and in group L, 0.46 ±
0.41 units of packed-cell were transfused. The difference in none of the variables
was statistically significant.
Conclusions: Although, there was no statistically difference between two
groups, however, it seems that IV administration of TXA is associated with lower Hb
drop and decreased blood transfusion. More studies are required.
OP16-229 TRANEXAMIC ACID 20 MG/KG VERSUS 30 MG/KG IN TOTAL HIP REPLACEMENT. A
PROSPECTIVE RANDOMIZED TRIAL
Hourlier, H1, Fennema P2, Reina
N3
1Polyclinique de la Thiérache, Wignehies, France; 2AMR advanced
Medical research, Mannedorf, Switzerland; 3Hopital Riquet, Toulouse,
France
Introduction/objectives: Tranexamic acid (TXA) reduces perioperative
blood loss and the need for transfusion. Little is known about the optimal dose of
TXA during total hip arthroplasty (THA) surgery. The aim of this study was to
compare two doses of TXA in THA.
Methods: We randomized 209 patients undergoing unilateral primary THA
performed by one surgeon into two groups of TXA doses: 20 mg/kg (low dose [LD]) (n =
104) and 30 mg/kg (high dose [HD]) (n = 105). TXA was administered prior to skin
incision via a 0.9% saline 100 ml venous solution. Uncemented components were
implanted using the modified minimally invasive anterolateral approach in all
patients. No surgical drains were used. The primary endpoint was blood loss up to
postoperative day (POD) 7. Secondary endpoint was the incidence of thromboembolic
events (TE) up to POD90. Blood loss was estimated by subtracting the haemoglobin
level (g/dl) at POD 7 from the baseline haemoglobin, and adding the number of packed
red blood cells (PRBC) transfused up to POD 7. Perioperative protocols included
standard thresholds for PRBC transfusion and the use of rivaroxaban for TE
prophylaxis.
Results: The two study groups were comparable in terms of baseline
characteristics. No significant difference in bleeding index was found: 2.68 ± 1.03
in the HD group and 2.84 ± 1.00 in the LD group (p = 0.276). No PRBC was transfused
in either group. No TE or other adverse events were noted up to POD 90.
Conclusions: The present study demonstrates reducing dosage from 30
mg/kg to 20 mg/kg does not significantly increase blood loss in patients undergoing
THA by a high-volume arthroplasty surgeon.
OP16-322 TRANEXAMIC ACID IN HIGH RISK TRANSFUSION GROUP: A COMPARATIVE
STUDY
de Sandes Kimura O, Freitas E, Linhares Garcia PB,
Leal DDC, Cury Fernandes MB
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: Total hip replacement (THR) is one of the
surgical procedures that has the highest success rate in functional improvement and
patient satisfaction. The procedure is associated with significant blood loss
leading to acute anaemia and transfusion requirements in 29.8% of cases.
Antifibrinolytic agents, such as aprotinin and tranexamic acid, have proven to be
effective in reducing blood loss, especially in cardiac surgery.
Methods: This is a prospective, randomized study conducted with 256
patients between December 2013 and March 2014. The sample was divided into two
groups: patients who received tranexamic acid (ATX group, n = 128) and patients who
did not (Control group, n = 128). The drug administration was carried out by
intravenous infusion bolus at a dose of 15 mg/kg.
Results: The ATX group showed less decline in Hb and Ht postoperative
(p<0.0001), as well as the blood loss volume during surgery, 652.9 ml. in the ATX
group and 1163.0 mL in the control group (p<0.0001). The need for blood
transfusion was reduced from 32% in the control group to 14.1% in the ATX group (p =
0.001). Among the patients who underwent blood transfusion, the use of tranexamic
acid resulted in a significant decrease in the infused blood volume (p<0.0001).
There was a significant reduction in rates of blood transfusion and blood volume
transfused in the group with risk factor for blood transfusion (pre-operative Hb
less than 13 g/dL). The hospital length stay was lower in the group using the ATX,
including the group with risk for blood transfusion.
Conclusions: The use of tranexamic acid intravenously in a single dose
before surgery is safe, reduces the operative blood loss and the need for
transfusion in patients undergoing THR.
OP17 Infection
OP17-284 RISK REDUCTION ON PJI WITH S. AUREUS ERADICATION THERAPY IN
THA
Thomas R, Koenraadt K, Joosten P, van Geenen R,
Bolder S
Amphia Ziekenhuis, Breda, The Netherlands
Introduction/objectives: Prosthetic joint infection (PJI) is a major
complication in THA. Nasal carriage with S. Aureus is a well-defined risk factor for
infection in hospitalized patients. Risk for infection is reduced up to 50% by
eradication therapy. Since PJI rates are very low and only 25% of the population are
carriers, significant differences are hard to show and reports on PJI have been
inconclusive. We analysed the effect of S. Aureus eradication therapy in THA.
Methods: From 2011, patients receiving THA are screened for S. Aureus
carriage and carriers are treated. This group was retrospectively compared with a
historical THA group in which no screening and eradication therapy was done. We
assumed similar carrier rates in both groups and calculated the risk reduction of
eradication therapy for PJI in comparison to the historical carriers without
treatment. Fisher's Exact test was used to compare outcome.
Results: 2072 patients were screened and 478 patients were positive
(23%). The historical control group consisted of 1248 patients, with 288 calculated
carriers (23%). 15 PJI (0.72%) occurred vs 14 (1.12%) in the historical group (p =
0.16). A 52% reduction in S. Aureus infections was found (0.33% vs 0.64% p = 0.15).
Infection rates for PJI caused by S. Aureus were similar in non-carriers and
carriers after eradication therapy (0.3 vs 0.4% p = 0.506). The calculated infection
rates in carriers in the historical group was reduced from 2.6% to 0.8% (RR 3,25, p
= 0.07) by eradication therapy and from 1.7% to 0,4% (RR 4,25, p = 0.07) for S.
Aureus PJI.
Conclusions: A clear trend in reduction of PJI was demonstrated as a
result of S. Aureus screening and eradication therapy, reducing the rate of PJI for
carriers to the same level as non-carriers.
OP17-431 PREPRINTED STICKER BUNDLES IMPROVE ANTIBIOTIC PROPHYLAXIS COMPLIANCE
IN ELECTIVE ORTHOPAEDIC SURGERY IN A DISTRICT GENERAL HOSPITAL
Dass D, Silk G, Brennan A, Price M
Weston General Hospital, Weston Super Mare, UK
Introduction/objectives: Antibiotic prophylaxis is recommended in
orthopaedic surgery when implants are to be used. Strict adherence to appropriate
dosages and timings improves outcomes by decreasing the risk of surgical site
infection and complications from inappropriate antibiotic use. An antibiotic
prescription sticker was introduced to try to improve the number of elective
orthopaedic patients undergoing THR and TKR in our unit receiving their antibiotics
appropriately.
Methods: This was a cohort-based study with a historical control study
group. 100 elective orthopaedic patients were chosen randomly for each arm of the
study pre and post introduction of the prescribing stickers. Mean age was 72.5 years
(Male: Female ratio 0.9:1.1). A “Golden Window” of up to one hour either side of the
prescribed time was allowed for administration of the antibiotics. Statistical
significance was set with a two-tailed alpha value of 0.05.
Results: Prior to the introduction of the stickers, 67% of patients
received all antibiotic doses within the Golden Window (n = 148 of 220). After this
intervention, 79% of antibiotics were administered within the Golden Window (n = 184
of 233). Fishers exact, two tailed - p = 0.0057. In both arms of the study, there
was diurnal variation and poorer compliance with accurate administration overnight
than the daytime (Day 79% vs Night 69% - Fishers exact, two tailed - p =
0.0205).
Conclusions: It was found that the use of pre-printed stickers
significantly improved the number of patients receiving antibiotics within the
Golden Window - up to one hour either side of the prescribed time. There was an
improvement from 67% compliance to 79%. There was slightly poorer compliance during
night time administration of antibiotics versus daytime.
OP17-355 USE OF IODINATED CONTRAST IN ASPIRATING INFECTED HIP JOINTS: AN IN
VITRO STUDY OF ANTIMICROBIAL PROPERTIES
Assiotis A1, Pengas I2, Kidd
S3, Cortes N3
1St. Mary's Hospital, London, UK; 2Royal Cornwall Hospital,
Truro, UK; 3Basingstoke & North Hampshire Hospital, Basingstoke,
UK
Introduction/objectives: Prosthetic hip joint aspiration is a key
component in the workup of a suspected infected total hip replacement. Prior to
aspirating joint fluid, the procedure often includes the injection of a contrast
agent so as to establish the intra-articular position of the needle or/and
demonstrate signs of component loosening. Iodine is a highly effective antimicrobial
agent and we aim to assess whether iodinated contrast agents affect in vitro growth
of common pathogen organisms. If this proves to be the case, we would consider
stopping the use of these agents in cases of suspected joint infections, so as to
increase the diagnostic yield of fluid cultures.
Methods: We examined the in vitro antimicrobial properties of two
iodinated contrast agents, which are routinely used for hip joint arthrography in
our institution in the context of joint aspiration. These agents were the Niopam 150
and Niopam 300 (Bracco UK Ltd) and these were placed undiluted on bacterial growth
plates. The pathogens that we used included several strains of methicillin-sensitive
Staphylococcus aureus, methicillin-resistant Staphylococcus aureus and
vancomycin-resistant Enterococcus and these were inoculated as a lawn on Oxoid
Columbia agar plates. Growth was assessed at 48 hours.
Results: There was no indication of any antibacterial activity in the
any of the plates that were inoculated with Niopam 150 and Niopam 300.
Conclusions: The two iodinated contrast agents that were examined in our
study can be safely used in hip joint arthrography, without concerns that this may
affect the diagnostic yield of microbiological growth of the joint aspirate.
OP17-159 SURFACE CHEMICO-PHYSICAL PROPERTIES OF CERAMICS FOR ARTHROPLASTY
REDUCE THE OCCURRENCE OF BIOFILM FORMATION
Rimondini L1, Cochis A1,
Barbati G2, Caracava C3, Chiesa R2
1Università del Piemonte Orientale, Novara, Italy; 2Politecnico
di Milano, Milan, Italy; 3Université de Lyon, Villeurbanne, France
Introduction/objectives: Periprosthetic joint infections are a
devastating complication, affecting 0.5 to 4% of primary total joint arthroplasties.
They are mostly caused by antibiotic resistance bacteria biofilm, strongly
recalcitrant to common pharmaceutical treatment. The key factor in preventing PJI is
to decrease bacterial adhesion affecting implants surface: this is a very complex
process, influenced by materials features and close local environment. The aim was
to verify the capability of high-tech ceramics (monolithic alumina, zirconia
platelet toughened alumina) to reduce bacteria biofilm adhesion by means of their
surface chemico-physical properties in comparison with Co-Cr alloy and XLPE.
Methods: Materials were characterized for roughness and surface
morphology, chemistry and wettability by laser profilometry, scanning electron
microscopy (SEM), atomic force microscopy (AFM) and contact angle measurements.
Total and selective amount of proteins adsorption from serum was evaluated by
Wester-blot analysis. Anti-bacterial adhesion materials properties were evaluated
after Staphylococcus aureus and epidermidis contamination by MTT assay, SEM
observation and 3D-morphometricanalysis.
Results: Ceramics resulted as more wettable (less than 51°) than Co-Cr
alloys and XLPE and were able to favour proteins adsorption (albumin, fibronectin,
collagen) in comparison with other materials. Such feature might be correlated with
biofilm adhesion and growth, since the ceramics were less colonized by both
Staphylococcus strains in comparison to metal surfaces (p<0.005) and XLPE
(p<0.005).
Conclusions: The high-tech ceramic surfaces were found to reduce the
bacteria biofilm adhesion, because of their chemico-physical surface properties.
OP17-297 ASPIRATION PNEUMONIA POST HIP FRACTURE IN AN ELDERLY POPULATION; A
DEADLY COMPLICATION
Fadulelmola A, Turaev A, Balasubramanian D
WWL NHS Foundation Trust, Wigan, UK
Introduction/objectives: Fracture neck of femur is a serious problem in
aging population. 64,838 people had hip fracture per year. Mortality within one year
of Fracture neck of femur (NOF) was reported between 20%-35%. The purpose of this
study was to investigate the commonest causes of death within one year following
NOF.
Methods: We have retrospectively analysed all deaths out of 299 NOF
admitted in Royal Albert Edward Infirmary Hospital between Jan 2014-Jan 2015. 23
cases have been identified however we could retrieve 18 case notes. Nottingham hip
score was used as a predictor of one-year mortality. The mean age was 81.2 (50-94)
years. Eleven (61.1%) were females.
Results: The mean score of Abbreviated Mental Examination was 5.7
(0-10). Nottingham hip score had a mean of 5.1 (2-8). Nine cases (50%) had
intracapsular NOF, and nine (50%) had Extra-capsular type of fracture. Nine (50%)
had managed operatively by cemented hemiarthoplasty of the hip, Six (30%) had
Dynamic Hip Screw, one (5.6%) had Intra- medullary nail and 2 managed
conservatively. All deaths were in hospital deaths. The mean length of hospital stay
was 18.5 (2-48) days. 12 (66.7%) had Aspiration pneumonia post NOF, 11 (61.7%) of
them died.
Conclusions: Aspiration pneumonia was found as the commonest cause of
death after NOF. Dementia and post-operative confusion are suggested as the main
risk factors. We had introduced a prevention program of aspiration pneumonia in our
unit, aiming to reduce mortality and morbidity post NOF.
OP17-315 STAPLES OR SUTURES FOR WOUND CLOSURE AFTER TOTAL HIP ARTHROPLASTY, A
MULTICENTER RANDOMIZED CONTROLLED TRIAL
1Tergooi Hospital, Hilversum, The Netherlands; 2Academic
Medical Center of Amsterdam, Amsterdam, The Netherlands; 3Sint Lucas
Andreas Hospital, Amsterdam, The Netherlands
Introduction/objectives: It is believed that wound closure with sutures
result in fewer complications compared to staples, however this is based on
underpowered studies with poor methodological quality. This study compared staples
and sutures for wound closure after Total Hip Arthroplasty (THA).
Methods: A multicentre randomized controlled trial was performed in 3
different hospitals. 503 patients receiving THA were included. Randomization was
performed in the operating room. 249 wounds were closed with staples, 254 with
sutures. The average age was 69.1 years (range 28-91) and 33.6% was male. There were
no significant demographic differences between the two groups. Follow-up occurred at
2, 6 and 12 weeks and at 1 year. Wound complications (prolonged drainage,
deep/superficial infection) and duration of admittance were scored using an online
platform. Significance level was set at p<0.05.
Results: The staples group had significantly more wound complications
compared to the sutures group (23% vs 8.7%; p<0.05). There was no significant
difference in wound infections (7.2% vs 3.1%). Significantly more prolonged wound
drainage was found in the staples group (14.9% vs 5.5%; p<0.05). Most wound
infections were treated with oral antibiotics. 9 patients received deep wound
irrigation and IV antibiotics, 5 in the staples group and 4 in the sutures group
(p>0.05). There was no difference in duration of hospital admittance (5.0 vs 4.7
days; p>0.05).
Conclusions: Wound closure with staples after THA result in
significantly more wound complications. With increasing number of THA's performed,
the impact of even small differences is clinically relevant.
OP17-269 TIMING OF IRRIGATION AND DEBRIDEMENT FOR PERI-PROSTHETIC TOTAL HIP
INFECTIONS
Schwarzkopf R, Sayeed Y, Camus T, Quien M, Adler
E
NYU Langone Medical Center Hospital for Joint Diseases, New York, USA
Introduction/objectives: Peri-prosthetic joint infections (PJI) are a
continued concern in arthroplasty surgery. The rate of PJIs for total hip
arthroplasty (THA) procedures varies from 0.3% to 2.9%. Irrigation & debridement
(I&D) with a head and liner exchange is often performed to treat this
complication. Early management of PJI is cited to offer a higher success rate. The
purpose of this study is to evaluate the efficacy and timing of I&D for PJI in
THA.
Methods: We reviewed the records of 39 patients that underwent a THA
between January 5th, 2009 and October 30th, 2014 who
subsequently had an I&D with a head and liner exchange to treat a PJI. Date of
THA and date of I&D with ahead and liner exchange were recorded. Success was
measured by the need for any additional procedure due to persistent infection.
Results: The average time between THA and I&D with a head and liner
exchange was 48 days. Successful I&Ds took place an average of 46.8 days after
the initial THA while unsuccessful I&Ds were performed 51.6 days after the
initial THA. The difference, however, was not statistically significant.
Conclusions: Our results demonstrate the average time to I&D with a
head and liner exchange was shorter for those who had a successful outcome but the
difference between the two groups was not significant. A short time interval between
arthroplasty and I&D is recommended by most authors but our results did not
support this view.
OP17-115 DIAGNOSIS AND TREATMENT OF EARLY SURGICAL SITE INFECTION AFTER HIP
ARTHROPLASTY
Filipenko V, Marushchak O, Bondarenko S, Mandus
A
Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
Introduction/objectives: Periprosthetic infection is one of the most
serious complications in arthroplasty. Early diagnosis and timely treatment of
infection make it possible to retain prostheses and significantly reduce the cost of
treatment.
Methods: In our Institute, 29 cases of surgical site infections (SSIs)
after total hip arthroplasty were observed from 2012-2015. The Coventry-Tsukayama
classification of the periprosthetic infection and classification of SSI developed
by CDC was used to determine the extent of the pathological process. 21 were
superficial, 8 were deep. Of the 21 superficial cases, 11 were identified for less
than 4 weeks after primary arthroplasty, 10 up to 8 weeks. Of the 8 deep cases, 3
cases were of type I (up to 1 month) and 5 cases were type II (one month later).
Debridement surgery was performed for all patients. Fistulectomy was carried out for
the superficial forms and DIAR was made for the deep forms. The follow up was
0.5-2.5 years after these operations.
Results: The use debridement surgery in the treatment of SSI after THA
in 21 cases gave a positive result with no recurrence. In cases of deep SSI, all
cases of recovery were observed with type I, and 2 cases of persistent remission
were noted with type II. 3 cases was recurrent infections were noted which required
the removal of the implant and installation antibiotic impregnated cement spacer
followed by revision surgery.
Conclusions: The use surgical debridement in treatment of SSIs after THA
gives satisfactory results if implemented up to 4 weeks after the appearance of
symptoms in cases of deep surgical site infection, and up to 8 weeks in cases
superficial SSIs. When this type of operations use in the deep late infection
recurrence rate reaches 60%.
OP17-423 ONE-STAGE EXCHANGE ARTHROPLASTY FOR CHRONIC PERIPROSTHETIC HIP
INFECTION
de Sandes Kimura O, Freitas E, Linhares Garcia PB,
Leal DDC, Cury Fernandes MB
Institute Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: Despite the great success of total hip
arthroplasty, deep infection remains one of the most devastating complications.
Successful eradication of infection with two stage procedures is reported to average
80% to 98%. On the other hand, one stage exchange shows 83% of success. The
comparable results suggest that the major factor for a successful outcome with
traditional approaches may be found in the quality of surgical debridement and dead
space management. The aim of this study was to prospectively analyse the outcome of
patients with a periprosthetic hip infection treated with one-stage exchange
arthroplasty.
Methods: We performed a prospective study including periprosthetic hip
infections treated with one-stage from January 2003 to January 2014. Direct exchange
was performed in chronic periprosthetic hip infection and pre-operative
identification of a microorganism from joint aspirate. Antibiotic-loaded bone cement
was used according to the joint aspiration. Antibiotic therapy was administered for
twelve weeks.
Results: Two hundred and forty patients with periprosthetic hip
infections with median infection duration of 90 days prior to our index surgical
procedure for infection were included. The most common offending organism was
gram-positive aerobes (75%), mainly S. epidermidis and S. aureus. After a median
follow-up of 94 months (24 to 132 months), the success rate was 84%.
Conclusions: One-stage exchange arthroplasty is an effective surgical
procedure in patients with periprosthetic hip infection. Precise identification of
the microorganisms, planning, debridement, appropriate intravenous antibiotic
therapy and post-operative specific patient care are key factors for successful
treatment.
OP17-352 TWO-STAGE EXCHANGE SURGERY PLUS EXTENDED ORAL COMBINED ANTIBIOTICS:
INFECTIOUS AND ORTHOPAEDIC RESULTS OF ORIGINAL SERIES AFTER MORE THAN 10 YEARS
FOLLOW-UP
Cordero-Ampuero J1, García-Rey
E2, Esteban J3
1Hospital Universitario La Princesa, Universidad Autónoma de Madrid,
Madrid, Spain; 2Hospital Universitario La Paz, Universidad Autónoma de
Madrid, Madrid, Spain; 3Fundación Jiménez Díaz, Universidad Autónoma de
Madrid, Madrid, Spain
Introduction/objectives: In 2007 a paper described the results of
combining 2-stage surgery (to eliminate biofilm) and extended oral antibiotics (to
treat intracellular bacteria according to Zimmerli) after a minimum 2-y follow-up.
We have analysed the evolution of the original series 10 years afterwards.
Methods: Prospective follow-up of 16 consecutive late hip arthroplasty
infection: 9 (56%) female, 72 ± 12 years (46-90) when 1st surgery.
Intraoperative cultures: 12 S epidermidis (5 methicillin-resistant, MR), 3 C
difteriae, 2 S aureus (1 MR), 2 P mirabilis, 1 E faecalis, 1 mixed anaerobes.
Antibiotics with biofilm and intracellular activity selected according to
antibiogram. 2nd-stage after clinical and serological (ESR, CRP)
normalization. Patients in-hospital 1 week after each surgery. Infection healing:
absence of clinical, serological and radiographic signs of infection along all
follow-up, which reached 9.8 ± 5.7 years (2-19) (7/16 died of unrelated causes).
Results: Infection healing: 15/16 (93.8%), no recurrence. Infection
persistence: 1/16, multiple unsuccessful soft tissue debridements, healed after bone
debridement at 7 years, died 3y afterwards. Definitive Girdlestone: 8/16, 4 rejected
more surgery (2/4 continued walking), 3 high surgical risk (Cierny C), 1 previous
non-walker. Reimplantation: 8/16, 7/8 no pain (1/8 sporadic), 8/8 walk more than 1
Km, 7/8 no support (1/8 crutch), 8/8 use public transport, 8/8 mild work
limitation.
Conclusions: From years ago, 2-stage exchange surgery plus oral combined
antibiotics is a demonstrated useful alternative therapy for late hip arthroplasty
infection. Good results maintain in the long term and are at least equivalent to
those obtained with conventional protocols.
OP17-101 TWO-STAGE REVISION OF INFECTED HIP PROSTHESIS FOLLOWED BY A SHORTENED
COURSE OF POSTOPERATIVE ANTIBIOTICS
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Shahid Beheshti University of Medical Sciences, Bone,
Joint and Related Tissue Research Center, Tehran, Islamic Republic of Iran
Introduction/objectives: Infection is one of the most serious
complications following total hip arthroplasty (THA) which is difficulty managed and
associated with several adverse consequences. We determined the outcomes of our
experience in two-stage treatment of infected THA followed by a shortened course of
postoperative antibiotics.
Methods: During a 15 months period, we treated 12 patients with infected
THA using a shortened post-operative course of antimicrobial chemotherapy. The
treatment protocol consisted of a two-stage exchange. In Step 1, the infected
components were removed and a hand-made antibiotic-cement spacer was inserted until
normalization of ESR and CRP. In stage 2, an uncemented prosthesis was
re-implantated in femoral side and patients received systemic postoperative IV
antibiotic for only one week. Patients were followed at minimum for 8 months.
Results: There was only one patient (a 83 year old man) developed
recurrent infection required girdlestone due to the aging. No patient required
revision THA because of asceptic loosening or mechanical instability.
Conclusions: The combination of effective-staged surgical debridement,
spacer of cement-antibiotic usage with waiting of normalization of ESR and CRP and
re-implantation with only one week course IV antibiotic usage, has led to encourage
early results in this series of revised chronic hip joint prosthetic infection.
OP18 Revision THA
OP18-198 REVISION REASONS AFTER REVISION TOTAL HIP ARTHROPLASTY: SINGLE CENTER
MID-TERM RESULTS
Introduction/objectives: The purpose of this study was to determine
fixation technique, bearing surface, surgical factors associated with re-revision
total hip arthroplasty.
Methods: We evaluated the re-revision rate with use of the institutional
total joint replacement registry. We identify 252 patients (352 hips) who had
undergone revision total hip arthroplasty. The minimum follow-up was 2.5 years
(mean, 7.5 years; range, 2-14). Fixation type (cemented, cementless, hybrid, reverse
hybrid), component replacement (acetabular only, femoral only, femoral and
acetabular, head and liner only) and bearing surfaces evaluated. Survivorship
analysis was conducted using the Kaplan-Meier method using second revision for any
reason as the endpoint.
Results: 62 hips (17%) underwent a second revision at a mean of 5.1
years (range, 0.08-11.9 years). Forty percent (98 hips) had a second revision for a
diagnosis different from that of their index revision. The most common reasons for
failure were aseptic loosening (38 of 62 hips, 61.2%), instability (8 of 62 hips,
12.9%), osteolysis and/or wear (8 of 62 hips, 12.9%), infection (6 of 62 hips,
9.1%), periprosthetic fracture (2 of 62 hips, 3.2%). Re-revision rate of cemented
implants (22%) and cementless implants (25%) showed not significant differences.
Patients, who had undergone index revision surgery for acetabular component only,
had the highest re-revision rates (38%). Survivorship for revision total hip
arthroplasty using second revision as endpoint was 78% (95% confidence interval,
69.57% to 86.25%) at 10 years.
Conclusions: Cemented or cementless fixation techniques at the time of
index revision had similar re-revision rates. Aseptic loosening was the most common
reason for failure.
OP18-350 FURLONG-HAP REVISION-STEM: MID-TERM CLINICAL AND RADIOGRAPHIC RESULTS
AND PROXIMAL BONE REGENERATION
Cordero-Ampuero J, Payo J, González-Fernández E,
Peñalver P
Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
Introduction/objectives: Papers of Furlong-HAP revision stem report 95%
survivorship after 8-12 years. But distal fixation may promote proximal osteopenia
and compromise regeneration of bone defects. We have analysed clinical and
radiographic results and evolution of proximal bone.
Methods: Retrospective observational: from 1997 to 2013, 64 stems were
implanted in 60 patients (35 females) of 70.2 ± 10.8 years (27-91) and followed for
8.2 ± 4.8 years (2-22). Cause for revision: 41 loosening, 9 periprosthetic
fractures, 6 infections, 4 stem breakages, 2 acetabular erosion (hemiarthroplasty),
1 osteotomy non-union, 1 recurrent dislocation. Pre-Operative defect: 23 cases
Paprosky type II, 7 IIIA, 19 IIIB. Pearson, Spearman, Mann-Whitney, Wilcoxonand
ANOVA.
Results: Complications: 7 (11%) intraoperative fractures, 5 (8%) distal
perforations, 9 (14%) acute infections (6 debridement, 3 suppressive antibiotics),
16 (26%) dislocations (3 cup exchange, 13 closed reductions), 4 (6.5%) aseptic
loosenings (2 re-revisions). Merlé at end of follow-up: 4.2 ± 1.2, 4.0 ± 1.3, 4.3 ±
1.2. Subsidence: 3.5 ± 5.1 mm, 15 stems (24%) over 3 mm. Postop osteolysis after
follow-up: 43% disappeared, 34% improved, 14% similar, 9% increased. New osteolysis
after follow-up: 11% patients (80% of them follow-up over 9 years). Radiographic
fixation: 60 stems (93.8%) bony ingrowth, 4 (6.5%) unstable. Femoral diameter, and
medial and lateral cortex increase in metaphysis and in proximal and distal
diaphysis, significant correlations only with male gender and lower Paprosky
type.
Conclusions: Revision surgery with Furlong-HAP long stem offers
medium-term bone-ingrowth, osteolysis healing and cortical bone regeneration, but
high rate of complications and subsidence.
OP18-103 LOCAL TRANEXAMIC ACID PLUS DILUTED EPINEPHRINE VS. INTRAVENOUS
TRANEXAMIC ACID FOR REDUCING BLEEDING IN REVISION TOTAL HIP ARTHROPLASTY
Taheriazam A1, Safdari F2,
Sahebalzamani MA3
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Shahid Beheshti University of Medical Sciences, Bone,
Joint and Related Tissue Research Center, Tehran, Islamic Republic of Iran;
3Science and Research Branch, Islamic Azad University, Tehran,
Islamic Republic of Iran
Introduction/objectives: Postoperative bleeding is one of the most
important problems after major orthopaedic surgeries including revision total hip
arthroplasty (RTHA). It has been demonstrate that tranexamic acid (TXA) is a useful
agent to reduce the blood loss volume. However, the more effective route of TXA
administration remained controversial. Furthermore, recent studies suggested that
diluted epinephrine (DEP) can be helpful to reduce the postoperative blood loss.
However, the findings are controversial. In current study, we compared the effects
of local TXA plus DEP and intravenous (IV) TXA on need to blood transfusion and
haemoglobin drop in patients underwent RTHA.
Methods: There were 80 patients underwent RTHA assigned randomly into
two equal groups: local TXA + DEP and IV TXA. In group IV, 4 g of TXA was
administrated systemically. In other group, the joint was irrigated with 4 g of TXA
plus 0.33 mg DEP (1:200,000). The pre- and post-operative level of haemoglobin (Hb)
was measured to determine the rate of Hb drop. Furthermore, the number of transfused
packed red blood cells was compared.
Results: Local TXA plus DEP significantly reduced total blood loss,
hidden blood loss and transfusion rate compared with IV TXA, without increasing the
risks of complications such as thromboembolic events.
Conclusions: Local administration of TXA plus DEP is an efficient and
safe method to reduce the blood loss and rate of blood transfusion in after RTHA
compared with IV TXA.
OP18-181 REVISION HIP ARTHROPLASTY AT STEM FRACTURES OF THE PROSTHESIS: A
RETROSPECTIVE ANALYSIS OF 10 CASES
Mezentsev V, Filippenko V, Zhigun A
Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
Introduction: Stem fracture after total hip arthroplasty (THA) is
uncommon. If such clinical situation occurs, it requires suitable approach
especially in a distal type of implant fixation.
Materials and methods: There were 10 patients (6 females, 4 males) with
age ranged 43-74 years, treated in a single clinical centre from 2010 to 2015. Stem
fracture occurred in 9 patients after cementless THA and in 1 case it occurs after
unipolar THA. Proximal fracture observed in 3 patients and in 7 patients we observed
fracture in the transitional zone between fixed and non-fixed implant parts.
Fracture occurred after primary THA in the period from 5 to 17 years
postoperatively. Surgical approach in the group analysed.
Results: In two cases it was possible to remove the distal fragment of
the stem without femoral osteotomy and in 6 patients femoral trap-door osteotomy
performed in the distal end of the stem. In 1 case trap-door osteotomy was extended
throughout the distal fragment of the stem and in one case - extended femoral
osteotomy performed. Bone fragments were fixed with wire in 9 patients, 1 femur
fixed with compression wire band. Modular cementless revision stems were implanted
in 4 patients, monoblock cementless revision Wagner type stems used in 2 patients.
We used revision stem of distal fixation with distal locking in 1 patient, 2
cemented stems (one primary and one revision, in both cases there was no femoral
osteotomy). In 1 patient femoral bone fracture occurred after 7 month, the required
plaiting.
Conclusions: Femoral stem fracture could occur as the result of implant
small cross-section, friction pair wear with polyethylene granuloma formation and
micro mobility of the proximal part of the stem. Stem removal demands appropriate
surgical approach and instruments. Utilization of revision implants with appropriate
length that covers osteotomy zone at least 3-4 cm is recommended.
OP18-246 DISTAL INTERLOCKING SCREWS WITH MODULAR REVISION STEM FOR REVISION
TOTAL HIP ARTHROPLASTY IN SEVERE BONE DEFECTS
Sala Pujals A, Leon Garcia A, Mingo Fernandez F,
Andriola V, Capurro Soler B, Tey Pons M, Marqués Lopez F
Hospital del Mar, Barcelona, Spain
Introduction/objectives: Stem revisions with an insufficient isthmus of
the femur represent a considerable challenge. In cases with Paprosky defects grade
IIIB and IV, proximal fixation of cementless revision stems cannot be considered
because of the extensive bone loss, and distally fixed extensively porous-coated
stems have high failure rates.
We aim to examine whether the modular cementless revision stem (Revitan curved;
Zimmer GmbH) is suitable for stem revisions with a defective isthmus when distal
interlocking screws are also used for fixation.
Methods: A prospective study of 27 patients undergoing a stem revision
with the Revitan curved stem with distal interlocking screws was designed. The Merle
d'Aubigné-Postel score (MAP) was used to evaluate the clinical improvements, the
Paprosky classification to grade the femoral defect and the Engh classification to
evaluate the biologic fixation of the stems. The statistical analyses were conducted
using the computer program SPSS for Windows (SPSS Inc, Chicago). The level of
significance was set at P<.05.
Results: This cohort included 12 females and 15 male with a mean age of
74.07 years (45-90). During a follow-up period of 36.69 months (13-71), there was 4
stem loosenings with screw breakage in a 3 cases, two of them because the stem was
too thin. According to Engh et al, bony ingrowth fixation of the stem occurred in 18
cases and stable fibrous fixation in 5 cases. There were two superficial infections
and one deep infection. The MAP rose continuously from 11.25 points pre-operatively
to 14.98 points at 12 months.
Conclusions: This concept of additional stem fixation with distal
interlocking screws represents a useful treatment option for revision arthroplasty
in rare cases of a defective isthmus.
OP18-148 CLINICAL RESULTS OF CABLE GRIP AND PLATE SYSTEM FOR GREATER
TROCHANTERIC REATTACHMENT IN REVISION TOTAL HIP ARTHROPLASTY
Imagama T, Tokushige A, Taguchi T
Yamaguchi University, Ube, Japan
Introduction/objectives: In revision total hip arthroplasty (THA), the
cable grip system is used for fixation after greater trochanteric fractures or
greater trochanteric osteotomy. Although the cable grip and plate system (CGP)
involving the subtrochanteric region is recently often used to improve fixation,
there have been a limited number of reports on the therapeutic outcomes of surgery
with this system.
Methods: This study included 34 hips in 33 patient used CGP in revision
THA. The mean age was 72.4 years, and the mean follow-up period was 4.2 years. The
reasons for the procedure were fractures in 23 hips, trochanteric pseudarthrosis in
7 hips, and greater trochanteric osteotomy in 4 hips.
Results: The Harris Hip Score improved on average from 38.2 before
surgery to 65.2 at the last follow-up examination. Radiographic assessment revealed
that bone union had been achieved in 25 hips, whereas pseudarthrosis had developed
in 9 hips (26.5%). The grip had superiorly migrated by 5 mm or more in 7 hips. The
cables were found to have been fragmented in 4 hips.
Conclusions: Silverton et al reported that the use of Doll-Miles cable
grip system after greater trochanteric osteotomy resulted in pseudarthrosis in 35%
of the cases. In our study, the use of CGP resulted in pseudarthrosis in 26.5%,
which was not exactly satisfactory. Because the traction force exerted by the
gluteus medius was very strong, the use of the grip system with locking screws may
be preferable.
OP18-92 TOTAL HIP ARTHROPLASTY FOR FUSED HIP
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Centre,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Conversion of a hip arthrodesis to total hip
arthroplasty is a rare and challenging procedure. Some authors have found that this
surgery is associated with increased complications and decreased survivorship of the
implant. We investigated the short-term results of THA in previously fused hips.
Methods: Between 2009 and 2012, we operated on 25 patients with
previously hip arthrodesis. The chief complaint was sever LBP in 8 patients, severe
ipsilateral knee pain in 11 patients and both in 6 patients. Furthermore, all of the
patients asked for more functional improvement and free hip range of motions. All of
the surgeries were performed by the same surgeon. The patients followed for 2
years.
Results: At the last visit, 21 patients were pain free or suffered from
mild pain. In these patients the pain intensity decreased from 7.1 ± 2.1 to 1.3 ±
0.9 based on visual analogue scale (VAS). These patients were able to independently
ambulate and perform activities of daily living. Harris hip score improved from 69.6
± 15.4 to 83.7 ± 6.5. Also, Oxford hip score decreased from 32.3 ± 8.7 to 19.6 ±
6.1. Two of the remaining patients had severe pain after the operation and two
others needed assistive devices for ambulation. Heterotrophic ossification occurred
in 2 patients but did not disturbed the joint ROM. Paresia of the common fibular
nerve occurred in 3 patients which resolved after 3 months in all of them. Limping
was found in 3 patients at the last visit.
Conclusions: THA in patients with fused hip can effectively relieve the
pain and improve the function. The procedure is technically demanding and patients
should be aware of high risk of complications. Also, the procedure may be not
helpful in some patients as they expect.
OP18-455 SLOOFF ACETABULAR RECONSTRUCTION IN AAOS TYPE III DEFECTS: FIFTEEN
YEARS FOLLOW-UP
1University Hospital Infanta Leonor, Madrid, Spain; 2University
Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain; 3Tan
Tock Seng Hospital, Singapore, Singapore; 4University Hospital Miguel
Servet, Zaragoza, Spain
Introduction/objectives: Acetabular impaction grafting (Slooff
technique) is commonly used in revision surgery of young patients. The aim of the
study was to analyse the long-term results with acetabular impaction grafting
technique (Slooff) in type III defects (AAOS classification).
Methods: We performed a retrospective study in 27 patients with AAOS
type III acetabular defects due to aseptic loosening. In all patients impaction
grafting, Slooff technique, were performed with one or two meshes. Mean follow up
was 15 years (minimum 11,6 years and maximum 18,7 years). Any acetabular revision
surgery, acetabular component migration or progressive radiolucent lines were
considered as failure cases. Statistical analysis was developed with SPSS 13.0 using
non-parametric tests.
Results: Mean age was 66,8 years. Survival rate at 15 years was 66,7%.
If we excluded septic loosening and dislocation cases, our survival rate increased
up to 88,9% at 15 years. Factors associated with mayor complications were: women,
older patients and more than two previous hip surgeries (p<0,05). Three cases of
early dislocation were treated with closed reduction. One patient with recurrent
instability was revised with a constrained acetabular component. Five cases of deep
infection were detected. Four were treated with two-staged revision surgery and one
with suppression antibiotic therapy. Two cases of aseptic loosening were treated
with acetabular component revision. One low demand patient with asymptomatic
acetabular migration was managed with conservative treatment.
Conclusions: Our study presents a survival rate 88,9% at 15 years with
aseptic loosening as end point. Older patients, women and more than two previous hip
surgeries are the risk factors for failure.
OP18-158 A MINIMUM 25-YEAR SURVIVAL OF ACETABULAR RECONSTRUCTIONS WITH
IMPACTION BONE-GRAFTING AND A CEMENTED CUP IN PATIENTS YOUNGER THAN FIFTY YEARS
OLD
Department of Orthopaedics, Radboud University Medical Centre, Nijmegen, The
Netherlands
Introduction/objectives: Acetabular bone deficiency is often a challenge
during total hip arthroplasty, and restoring the bone loss is especially attractive
in younger patients. No other studies presenting minimal twenty-five year follow-up
are known in young patients. The aim of this study is to present the long-term
clinical and radiographic results of these acetabular reconstructions in young
patients under 50 years.
Methods: Between 1979 and 1987, we performed 42 consecutive acetabular
reconstructions (23 primary, 19 revisions) using the impaction grafting technique
and cemented cups. Radiographs and clinical parameters were prospectively collected.
Kaplan-Meier (KM) methods were performed to estimate survival. To account for
deaths, we also performed competing risk survival analyses.
Results: Mean follow up was 30.3 years (range 27-35) with 1 patient lost
to follow-up. Mean age at index surgery was 37 years (range 20-49). 11 patients died
(14 hips). None of the 11 surviving reconstructions showed radiographic loosening.
Mean Harris hip score at review was 88 (range 58-99) and mean Oxford Hip
Questionnaire Score was 20 (range 12-40).
The KM survival for end point revision for any reason was 50% (95% CI: 32-65) at 25
and 40% at 30 years (95% CI: 23-56). The KM survival for revision for aseptic
loosening was 70% (95% CI: 50-83) at 25 and 56% (95% CI: 35-73) at 30 years whereas
the revision free rates based on CR for endpoint aseptic loosening were 74% (95% CI:
61-90) at 25 and 64% (95% CI: 49-83) at 30 years.
Conclusions: Impaction bone grafting can be used as a long-term solution
for demanding primary and revision acetabular reconstructions.
OP18-4 FIVE TO 13-YEAR RESULTS OF A CEMENTED DUAL MOBILITY SOCKET TO TREAT
RECURRENT DISLOCATION
1Hop Cochin, APHP, Paris 5, Paris, France; 2CHU Rennes, Rennes,
France; 3Clinique Mutualiste, Lorient, France; 4CH Pont Labbe,
Pont Labbe, France
Introduction/objectives: The purpose of this retrospective study was to
evaluate the outcome of a cemented DM socket to treat recurrent dislocation after a
minimum of 5-year follow-up.
Methods: The series included 51 patients with a mean age of 71.3 ± 11.5
years presenting with recurrent dislocation. A single DM socket design was used
consisting of a stainless steel outer shell with grooves with a highly polished
inner surface articulating with a mobile polyethylene component.
Results: At the minimum 5-year follow-up evaluation, 18 of the 51
patients deceased at a mean of 4.8 years, three were lost to follow-up at a mean of
1.4 years, seven had been revised at a mean of 4.7 years, and the remaining 23 were
still alive and did not have revision at a mean of 8.2 ± 2.4 years (range, 5-13
years). Of the seven revision, three were performed for further episodes of
dislocation (at the large bearing for one patient, and intra-prosthetic for two
patients) after a mean 5.9 ± 2.9 years (range, 2.7-9.1), whereas two were performed
for late sepsis and two for aseptic loosening of the acetabular component.
Radiographic analysis did not reveal any further loosening on the acetabular side.
The survival rate of the cup at 10 years, using re-dislocation as the end-point, was
86.1 ± 8.4% (95% confidence interval, 69.7-100%). The survival rate of the cup at 10
years, using revision for any reason as the end-point, was 75.2 ± 9.3% (95%
confidence interval, 56.9-93.5%).
Conclusions: A cemented dual mobility cup was able to restore hip
stability in 96% of recurrent dislocating hips up to 13-year follow-up with none of
the complications associated with constrained devices, as mechanical failure
occurred in only 3.9% of the patients of this series.
OP19 THA Varia
OP19-266 CO-INFECTION WITH HEPATITIS C AND HIV IN TOTAL HIP ARTHROPLASTY: AN
INCREMENTAL EFFECT OF DISEASE BURDEN
NYU Langone Medical Center Hospital for Joint Diseases, New York, USA
Introduction/objectives: Individuals co-infected with both HCV) and HIV
represent a unique and growing population of patients undergoing orthopaedic
surgical procedures. Data regarding complications for HCV monoinfection or HIV
monoinfection is robust, but there exists a paucity of data regarding co-infected
individuals.
Methods: State-wide database was used to identify patients undergoing
THA between 2010-2014. Patients were stratified into 4 groups based upon HCV/HIV
status: healthy controls without disease, HCV monoinfection, HIV monoinfection, and
co-infection. Differences regarding hospital LOS (days), total charges ($USD),
discharge disposition, in-hospital complications, in-hospital mortality, and
hospital readmission were calculated.
Results: 80,722 patients underwent THA between 2010-2014. 98.55% had
neither HCV nor HIV, 0.66% had HCV, 0.66% HIV and 0.13% were co-infected with both
HCV and HIV. Co-infected patients were more likely to be younger, male, insured by
Medicaid, history of AVN and be homeless. Additionally, co-infected patients had the
highest rates of alcohol abuse, drug abuse, tobacco, and high rates of psychiatric
disorders, including depression. HCV and HIV co-infection was an independent risk
factor for increased LOS (p<0.001), total hospital charges in the 90th
percentile (p<0.001), having 2 or more in-hospital complications (p<0.001),
and 90-day readmission rates (p<0.001).
Conclusions: As the prevalence of HCV and HIV co-infectivity continues
to increase, surgeons will encounter a greater number of these patients. Awareness
of the demographic and socioeconomic factors leading to increased complications
after THA will allow physicians to consider interventions to improve patient health
status in order to optimize outcomes and reduce costs.
OP19-189 OCHRONOSIS AS THE DARKER OSTEOARTHROSIS-CLINICAL CASE
Sá Rodrigues A, Seara M, Dopico C, Antunes A, Mateus
A, Pinto R
Hospital Sao João, Porto, Portugal
Introduction/objectives: Ochronotic arthropathy (OA) is a rare condition
found in patients with alkaptonuria in which is seen an accumulation of an
ochronotic pigment in all connective tissues, including in cartilage. Here we
present a new case of a patient submitted to a total hip arthoplasty surgery that
didn't know about his condition until surgery was performed showing the so-called
black cartilage disease.
Methods: We present a case of a 65-year-old Caucasian woman with no
relevant clinical history. Physical and radiographic examination was compatible with
the diagnosis of coxarthrosis. The patient was proposed to a cementless right total
hip replacement.
Results: During the surgical dissection we came across with a hip with
black cartilages. Since the macroscopic evaluation of bone quality seemed reasonable
we maintained our initial plan and finished the cementless total hip replacement
without other complications. After surgery we realized that patient had darker
sclera and ears cartilage as also a dark urine. Post-op progressed uneventfully and
after having been evaluated by rheumatology the patient was diagnosed with
alkaptonuria.
Conclusions: OA is usually asymptomatic until the involvement of the
joints and might be neglected even when the surgeon proposes the patient to surgery.
Therefore, orthopaedic surgeons must have attention and insight to suspect of an OA
before surgery so as to not be overwhelmed during surgery with the presence of
darkened cartilage, in order not to change the predetermined plan. Due to its low
prevalence, there is short literature concerning special features to be considered
during arthroplasty in patients suffering from this disease and so more studies are
needed in order to be defined the best form of treat these patients.
OP19-313 LIPOSCLEROSING MYXOFIBROUS TUMOR: A RARE TUMOR IN THE HIP
Garcia P, Rinaldi E, Caruso A, Almeida A, Aymoré I,
Meohas W, Aguiar D
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: First described in 1986, Liposclerosing myxoid
fibrous tumour (LSMFT) is a benign bone lesion characterized by a complex mixture of
various histological elements, including lipoma, fibrous tissue, cyst formation and
ischemic bone. Despite its typical characteristics, is considered an extremely rare
tumour. The differential diagnosis includes intraosseous lipoma and fibrous
dysplasia. The purpose of this study was to show our cases of LSMFT.
Methods: A retrospective case series was conducted with nine patients
with LSMFT, two males (22.2%) and seven women (77.8%), mean age 39 years (19-53).
Five patients (55.5%) were black and four white (44.4%).
Results: The time of complaints and the diagnosis ranged between six and
sixty months (mean 27 months), and three (33.3%) underwent pathological fracture.
The main affected bone was the femur (77.7%). The distal tibia and the iliac each
accounted 11.1% of cases. Six patients had a tumour in the proximal metaphyseal
region of the femur. The mean follow-up from the histopathologic diagnosis was 39
months (6-88). Intralesional curettage and grafting was used in seven patients. One
patient required a transtibial amputation due to malignancy for low-grade
osteosarcoma. There were no complications related to surgery. There was no
recurrence, metastases or deaths.
Conclusions: LSMFT affects men and women in the fourth decade of life,
with no ethnic predilection. Have major preference for the femur (85% of lesions),
90% of the intertrochanteric region, as shown in this study. The risk of malignant
transformation to osteosarcoma or malignant fibrous histiocytoma was estimated
between 10 and 16%. In the present study, 11.1% of patients had malignant
osteosarcoma to low grade.
OP19-75 THE INTERACTION OF KNEE, HIP AND L5-S1 JOINT CONTACT FORCES BETWEEN
SOUND AND PROSTHETIC LEG IN PATIENTS WITH UNILATERAL BELOW-KNEE AMPUTATION
DURING WALKING
Kamali M
Isfahan University of Medical Science, Isfahan, Islamic Republic of Iran
Introduction/objectives: The aim of this study was to assess the
interaction of knee, hip and L5-S1 joint contact forces between sound and prosthetic
leg in patients with unilateral below-knee amputation during walking.
Methods: Five patients with TTA and mean ± standard deviation of weight
of 73.5 ± 7.3 kg and height of 172.5 ± 2.9 cm were recruited in this study. The
patterns of knee, hip and L5-S1 joint contact forces were studied. Open- SIM and
Visual 3D software were used to model the subjects.
Results: The mediolateral (p = 0.02) and first and second peak of
anteroposterior (p = 0.00) ground reaction forces applied on sound leg were
significantly higher than prosthetic leg. The forces applied on hip and knee joint
in sound leg were 428 N and 426 N respectively lower than prosthetic leg while the
forces applied on L5-S1 joint during the stance phase of sound leg were 524.2 N
greater than that of L5-S1 joint during the stance phase of prosthetic leg (p =
0.00).
Conclusions: There was a significant interaction between the joint
contact forces pattern of hip, knee and L5-S1 joint in sound and prosthetic leg. The
knee and hip joint in prosthetic leg bear higher vertical joint contact forces while
the L5-S1 joint in stance phase of sound leg bear higher vertical joint contact
forces. These degenerative forces would endanger the joints and lead to
osteoarthritis. Therefore, usage of the best quality prosthetic absorbing more
forces in the ankle should be considered in patients with trans-tibial
amputation.
OP19-6 INCIDENCE AND OUTCOME OF ACUTE KIDNEY INJURY (AKI) IN TOTAL JOINT
ARTHROPLASTY (TJA) POST INTRODUCTION OF ENHANCED RECOVERY PROTOCOL: A GRANTHAM
EXPERIENCE
Rajagopalan S, Bagheri H, Ismail J, Abou-Foul
M
Grantham Hospital, Grantham, UK
Introduction/objectives: The incidence of AKI following elective joint
replacements is low, with most studies reporting an incidence of <2%.
The aim of our study is to retrospectively review the elective, primary TJA
performed, post introduction of enhanced recovery protocol at our hospital, to
ascertain the incidence of post-operative AKI and determine the outcome associated
with this complication in our population, which may be amenable to pre-operative
identification and targeted intervention.
Methods: Retrospective medical record review of consecutive primary,
elective TJA procedures using enhanced recovery protocol was undertaken. Period of
study was 6 months, from September 2014 till March 2015. Demographic, peri-operative
and post-operative data were recorded.
Results: Total number of patients, n = 186. 54% were total hip and 46%
were total knee arthroplasty. 15 out of 186 patients had AKI postoperatively, giving
us an incidence of 8%. 14 of these patients were above the age of 65. 60% of these
were male patients. 40% of these patients had a baseline e-GFR of <60%
pre-operatively. 80% had Stage I, 13% had Stage II and 6% had Stage III AKI.
Following the appropriate medical management the creatinine level came back to
baseline levels in 3 to 8 days in all the patients.
Conclusions: This study showed a rate of AKI of 8% in our total joint
arthroplasty population, substantially higher than previously reported. Given that
AKI and long-term complications are associated, prospective research is needed to
further understand the associated factors and predict those at risk of AKI. NHS
Kidney Care has estimated that the cost to the NHS per annum is £500 million. There
may be opportunities to maximize the pre-operative medical management and mitigate
risk.
OP19-124 TOTAL HIP ARTHROPLASTY IN END STAGE RENAL DISEASE WITH FEMORAL NECK
FRACTURE
Aminjavaheri S, Mortazavi SMJ
Tehran University of Medical Science, Joint Reconstruction Research Centre, Tehran,
Islamic Republic of Iran
Introduction/objectives: End-stage renal disease (ESRD) patients have
metabolic bone disorder, which make them prone to femoral neck fracture with higher
risk of complications after internal fixation (IF) like avascular necrosis (AVN) and
non-union. In this series we analysed the outcomes of treatment in a consecutive
series of displaced femoral neck fractures.
Methods: We included 9 ESRD patients with Garden type 3 or 4 femoral
neck fracture over a 2-year period. All of them underwent total hip arthroplasty
(THA) with cemented component in eight patients. Only one patient underwent
non-cemented THA who had revision arthroplasty one year later. Six patients have
been operated with direct anterior approach and three patients with direct lateral
approach.
Results: The mean age of our patients were 73 (range 56-82) and male to
female ratio was 2/1. Only five cases remembered a history of simple falling before
fracture. The mean time for dialysis was 120 months (range 26-248). We found no case
of infection or dislocation postoperatively in mean follow up of 18 months (range
15-27 months). Only one 77 year-old male died 18 months after surgery due to
ischemic heart disease. The mean Harris Hip score improved significantly from 37 at
the beginning to 78 at last follow up (P<0.05).
Conclusions: We believe ESRD patients with displaced femoral neck
fracture should be underwent THA instead of IF because of low complication rates
after arthroplasty. On the other hand, we had no IF-related complications like
non-union, AVN, pseudoarthrosis, or a failed osteosynthesis total hip
arthroplasty.
OP19-308 TOTAL HIP ARTHROPLASTY IN SICKLE CELL ANEMIA
Garcia P, Sousa Filho P, Bitu O, Kimura O, Freitas E,
Fernandes M
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: The Sickle Cell Disease (SCD) is an autosomal
recessive genetic condition resulting from defects in the structure of haemoglobin.
The incidence of avascular osteonecrosis of the femoral head in patients with SCD
varies between 3% and 50%. Total hip arthroplasty (THA) is the treatment of choice
for articular collapse, found in the late stages of osteonecrosis. The purpose of
this study was to evaluate the clinical and radiographic outcomes of total hip
arthroplasy in sickle cell patients.
Methods: We performed a longitudinal, prospective, descriptive study
with patients with SCD who underwent THA. Exclusion criteria were follow-up less
than 12 months and damaged postoperative radiographs.
Results: We performed 41 hips in 31 patients. The mean follow-up was of
9.6 years. Fifteen (48.3%) were male and the average age of 34.5 years (18-55
years). The mean score of Functional Harris was 29.01 pre-operatively and 93.09
postoperatively. The overall rate of reoperation was 17.9%, and periprosthetic
infection the most common reason (10.2%). Revision for aseptic loosening was
performed in two hips (4.8%) and one (2.4%) patient required septic review. The
overall survival of implants in seven years was 92.8%.
Conclusions: Recent studies have shown that multidisciplinary approach
has improved the outcome in these patients. Yet, failure rates remained high. Our
results were similar to those found in recent studies, especially in the rate of
reoperation for periprosthetic infection. Although the clinical and surgical
management has improved, there are still few studies on this topic. Although
complications are more frequent and severe, these results show that we can see good
survival of THA in these patients, which confirms the cost-benefit of the
procedure.
OP19-290 PRIMARY AND REVISION THA IN PATIENTS WITH SICKLE CELL DISEASE.
EXPERIENCE FROM 50 CASES (41 PRIMARY THA, 9 REVISION THA) OVER 5 YEARS.
RETROSPECTIVE ANALYSIS OF DISEASE SPECIFIC TREATMENT DEMANDS
Röttinger H
Chirurgisches Klinikum München Süd, Munich, Germany
Introduction/objectives: Sickle cell trait occurs in 10% to 30% of
people in eastern Mediterranean area and Middle East. Only the homozygous genotype
HbSS results in sickle cell disease (SDC). SCD patients in orthopaedics admit mainly
with femoral head necrosis often with the consequence of total hip arthroplasty
(THA). Without a doubt the peri- and postoperative complications in sickle cell
patients with THA are more numerous than after routine THA. How to deal with these
patients?
Methods: Sickle cell patients are anaemic. Transfusions are used in the
pre-, peri-and postoperative period to prevent from life-threatening acute SCD
crisis. The two primary goals of transfusions are to increase the low
oxygen-carrying capacity and to improve microvascular perfusion. We started with
transfusions pre-operatively: One unit at the evening before surgery, one unit at
the morning of surgery (transfusion to Hb = 10 g/dL, HbS <60%). In cases of HBS
>90% we preferred a partial blood exchange. During surgery the blood loss was
directly substituted by transfusion. THA implantations in patients with SCD are
demanding, since the bone stock shows substantial changes to the routine. K-wire and
fluoroscopic guidance is often required for femoral drilling.
Results: The retrospective study presents our experience over the last 5
years in 50 cases with THA in SCD (41 primary THA, 9 revision THA including 3 MSRA
infections). In all patients we used cementless implants, all primary THA were
performed in MIS technique. So far no implant loosening or infection was observed.
No patient developed an acute crises peri- and postoperatively.
Conclusions: THA in patients with SCD demands on specific treatment
protocols and extended pre-operative arrangements to minimize the surgery related
increased risks.
OP19-240 GREATER MUSCLE DAMAGE IN DIRECT ANTERIOR APPROACH WHEN COMPARED TO
THE DIRECT SUPERIOR APPROACH FOR TOTAL HIP ARTHROPLASTY
1Stryker, New Jersey, USA; 2Sanford University, Redwood City,
USA; 3Ann Arbor Orthopaedic Specialists, Ypsilanti, USA;
4Desert Regional Medical Center, Palm Springs, USA; 5Mayo
Clinic, Rochester, USA
Introduction/objectives: Direct anterior (DA) surgeons recognize the
need for posterior releases to elevate the femur during total hip arthroplasty. The
exact structures and extent of releases have not been carefully delineated. We
define the extent and location of muscle and tendon damage during DA approach and
compared this to the direct superior (DS) approach.
Methods: In eight cadavers, the DA approach was performed on one side
and the DS approach on the other. The extent of muscle and tendon damage was
measured and the percent damage to each anatomical structure was calculated.
Results: The DA approach caused substantially greater damage to the
gluteus minimus muscle and tendon when compared to the DS approach. The mean amount
of damage to the gluteus minimus muscle was 9 ± 8% of its muscular surface area in
the DA approach and 2 ± 2% of its muscular surface area in the DS approach (p =
0.049). The mean amount of gluteus minimus tendon transection during femoral
mobilization was 60 ± 35% of its tendinous width in the DA approach and 3 ± 7% of
its tendinous width in the DS approach (p = 0.003). The tensor fascia latae and
rectus femoris muscles were damaged only in the DA approach. There was no difference
in the amount of damage to the gluteus medius muscle and tendon, piriformis tendon,
obturator internus tendon, obturator externus tendon, or quadratus femoris muscle
between approaches.
Conclusions: The posterior soft tissue releases of the DA approach
damaged the gluteus minimus muscle and tendon, the piriformis tendon, and the
obturator internus tendon. Further clinical outcome studies, radiographic evaluation
of component position, gait analyses, and serum biomarker levels are necessary to
evaluate and corroborate the safety and efficacy of the DS approach.
OP19-149 CHRONIC HIP ABDUCTOR DEFICIENCY REPAIR: A COMPARISON OF DIRECT REPAIR
VERSUS MUSCLE TRANSFER
Kurincic N, Trebse R
Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
Introduction/objectives: Chronic abductor muscles deficiency of the hip
may cause severe lateral trochanteric pain, weakness and limp requiring walking
supports. Only a few reports on the results of abductor tendon complex reinsertion
are available in the literature. Promising results following reconstruction with
local muscle transfer are reported. This study reports the clinical outcome of hip
abductor deficiency repair using transoseus sutures on 3 patients and local muscle
transfer on 11 patients.
Methods: A retrospective analysis was conducted of 14 consecutive
patients with a severe limp because of abductor deficiency confirmed on MRI scans.
The mean age of the patients (4 men and 10 women) was 68.5 years (33 to 84), with a
mean follow-up of 14 months (1 to 34).
Results: All three patients treated with direct abductor tendon complex
reinsertion using transoseus sutures did not improve with surgery.
On the other hand, 11 patients treated with gluteus maximus and/or tensor fascia lata
muscle transfer achieved good results. On average they had less pain, reduced limp
and reduced use of walking supports. Final Harris hip score was good in five
patients, fair in three and poor in none. 7 patients are very satisfied with the
procedure, one satisfied, none dissatisfied. For 3 patients the follow-up is too
short for final evaluation.
Conclusions: Local muscle transfer seems a promising solution for hip
abductor deficiency, which remains difficult, and often neglected orthopaedic
problem. In our experience, its results are superior compared to reinsertion
alone.
OP19-433 CLINICAL OUTCOMES FOR THE TREATMENT OF AMORPHOUS CALCIFICATION OF THE
LABRUM DURING HIP ARTHROSCOPY WITH MINIMUM TWO-YEAR FOLLOW-UP
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: Amorphous calcifications (AC) of the hip are
uncommon entities, and their etiology and outcomes after treatment remain unclear.
Our purpose was to evaluate clinical outcomes, satisfaction, demographics, and
radiographic findings for patients whose hip arthroscopies involved AC excision with
treatment of labral tear and/or femoroacetabular impingement (FAI).
Methods: Between October 2008 and July 2013, 12 patients underwent
primary arthroscopy and excision of AC in the antero-superior labral-capsular recess
between October 2008 and July 2013. Demographics, radiographic findings,
intra-operative findings, and procedures were reviewed. Minimum follow-up was two
years and included patient satisfaction, and the following patient-reported outcome
(PRO) scores: mHHS, NAHS, and HOS-SSS.
Results: Twelve females were included in the study (mean age: 39.9
years, mean follow-up: 39 months). One hip (8%) converted to total hip replacement
after two years. Improvements were observed between pre-operative and latest
follow-up scores for mHHS (20.2), HOS-SSS (29.1), and VAS (-3.1). While mHHS
improved, it was not found to be statistically significant, although HOS-SSS and VAS
improvements were (p<0.0001). Eight of 11 patients in this cohort (72.7%) had
satisfaction of 7 or greater. Post-operative radiographic findings showed no
subsequent ACs. No complications were reported. Two of 11 (18.2%) patients had
histories of hypothyroidism, which significantly different (p = 0.03) compared to a
large census (4.6%).
Conclusions: The treatment of AC as a part of hip arthroscopy
demonstrates significant improvements in PROs and VAS with minimum two-year
follow-up. Hypothyroidism may be a risk factor for the development of AC, and this
relationship should be further investigated.
OP19-25 FUNCTIONAL OUTCOME OF TOTAL HIP ARTHROPLASTY AFTER PREVIOUS HIP
ARTHROSCOPY: A RETROSPECTIVE COMPARATIVE COHORT STUDY
Jain M1, Board T1, Hakimi
M1, Shaw D1, Jackson R2, Siney
P1, Jain M1
1Wrightington, Wigan and Leigh NHS trust, Wigan, UK;
2University of Liverpool, Liverpool, UK
Introduction/objectives: Despite patients demonstrating significant
short term clinical improvement from a Hip Arthroscopy (HA), a number of patients
progress to full blown osteoarthritis of the hip for whom a total hip arthroplasty
(THA) stands as a definitive surgical option. The aim of the study was to compare
the short-term functional outcome of patients who had a Hip Arthroscopy and a
subsequent uncemented Total Hip Arthroplasty (THA) against patients who underwent
THA for primary arthritis or avascular necrosis of the hip.
Methods: Between 2010 and 2013, in a group of 414 patients who had a hip
arthroscopy, there were 18 patients who underwent a subsequent uncemented THA. These
formed the study group. During the same period, 625 patients underwent an uncemented
THA performed for primary OA or AVN, of which 64 patients matched the study group
for age, follow up and implant used. These formed the control group. Pre-op and
post-op Oxford scores were recorded for all patients who had a primary uncemented
THA. Medians and associated interquartile ranges were calculated and an unpaired
t-test used to calculate statistical significance.
Results: An average follow up of 26.5 and 26.3 months was observed in
the study and control groups respectively. The median (interquartile ranges) preop
scores were 14 (8.25, 17.0) and 18.5 (13.25, 24.75) in the two groups. Corresponding
post-op scores were 40 (31.25, 45) and 46 (43, 48). Median difference between the
pre-op and post-op oxford score were 27 (19, 31) and 25 (18.25, 31). There was no
significant difference between the study group and the control group (p = 0.88).
Conclusions: A previous HA does not have a negative impact on the
short-term functional outcome or have an effect on the incidence of infection after
a subsequent uncemented THA.
OP20 Trauma 1
OP20-28 LEG LENGTH DISCREPANCY FOLLOWING HIP HEMIARTHROPLASTY IN THE
MANAGEMENT OF INTRACAPSULAR FEMORAL NECK FRACTURES: A RETROSPECTIVE COMPARISON
OF THOMPSON VS EXETER TRAUMA STEM
Robinson P, Tyler J, Slater G
Tunbridge Wells Hospital, Pembury, UK
Introduction/objectives: Leg length discrepancy is a significant cause
of patient dissatisfaction following hip hemiarthroplasty. Several different
prosthesis exist for the management of hip fractures; varying in both design and
cost. The aim of the present study was to compare post-operative leg length
discrepancy between two commonly used stems: Thompson and Exeter Trauma Stem (ETS).
We hypothesised that a collared stem (i.e. Thompson) was more likely to lead to
postoperative leg length discrepancy than a non-collared stem (i.e. ETS), being more
dependent on femoral neck cut.
Methods: A retrospective review was carried out of hip
hemiarthroplasties undertaken for intracapsular hip fractures over a six month
period. All patients with intracapsular hip fractures managed with either Thompson
or ETS hemi-arthroplasty were selected yielding an initial cohort of 119 patients.
30 AP pelvis radiographs were non-diagnostic for leg length discrepancy and were
discounted. 89 Radiographs (58 ETS and 31 Thompson) were independently analysed for
leg length discrepancy by two independent reviewers using PACS Centricity.
Results: The average post-operative leg length discrepancy using ETS was
+ 1.93 mm (range −23 to + 20 mm) and + 1.94 mm (range −11 to + 18 mm) using the
Thompson stem. The mean difference between the two prostheses was 0 mm (95% CI:
−3.69 to 3.68, P 0.998). Pearson's Correlation Coefficient between reviewers was
0.83.
Conclusions: Our study indicates that there is no significant
statistical difference in post-operative leg length discrepancy between the Thompson
prosthesis and ETS when used in the management of femoral neck fractures. As such we
conclude that leg length discrepancy should not be a major consideration in the
choice of whether to use a collared or non-collared stem.
OP20-300 COMPARISON OF TREATMENT OUTCOMES IN UNSTABLE INTERTROCHANTERIC
FRACTURE'S PATIENTS BETWEEN CEMENTED NON-CALCAR REPLACEMENT BIPOLAR
HEMIARTHROPLASTY WITH WIRING AND CEPHALOMEDULLARY NAILING FIXATION
Vejjaijiva A, Sriphirom P
Rajavithi Hospital, Bangkok, Thailand
Introduction/objectives: The treatment goal in intertrochanteric
fracture is a stable fixation and early full weight bearing mobilization. In elderly
patients who usually have some degree of osteoporosis, these are often associated
with failure of fixation. Some surgeons recommended prosthetic replacement
treatment, as it gives stability and allows immediate full weight bearing. There is
no consensus in terms of treatment outcomes between prosthesis replacement and
fixation.
Methods: This retrospective study was performed on 54 patients with
unstable intertrochanteric femoral fracture. 28 treated with cemented non-calcar
bipolar hemiarthroplasty and restored the femoral calcar by wiring. 26 treated with
cephalomedullary nailing fixation. Intraoperative data such as operative time and
intraoperative blood loss were recorded. Postoperative data as blood transfusion,
duration of hospital stay, time to full weight bearing, Modified Harris Hip Score
and complication after treatment were collected at least 6 months later.
Results: There were no significant differences in sex (P = 0.637), age
(P = 0.205), Sigh index (P = 0.930), duration of hospital stay (P = 0.952), blood
transfusion (P = 0.074) and Modified Harris Hip Score (P = 0.062) between two
groups. However, operative time and intraoperative blood loss were significantly
higher in arthroplasty group compared to nailing fixation group, P<0.001 and
P<0.001 respectively. On the other hand, time to full weight bearing were
significantly lower in arthroplasty group, P<0.001 2 cases in nailing fixation
group had implant failure.
Conclusions: This prosthesis replacement technique produces good
treatment outcome and the result also implies that arthroplasty group allow
immediate full weight bearing without postoperative complications.
OP20-71 CHOICE OF INTERNAL FIXATOR FOR FRACTURES AROUND THE FEMORAL TROCHANTER
DEPENDS ON AREA CLASSIFICATION
1Department of Orthopaedic Surgery, Akita University, Akita city, Japan;
2Akita Hip Research Group, Akita city, Japan
Introduction/objectives: In femoral trochanteric fracture, fractures
extending to the basal neck or subtrochanteric area are highly unstable. We
investigated associations between clinical results and treatment choice for type 3
(fracture line only in trochanter part), 2-3 (fracture line spreading through in
basal neck from trochanter part), and 3-4 (fracture line spreading through
subtrochanteric part from trochanter part) fractures.
Methods: Proximal femoral fractures in 482 patients admitted to 6
general hospitals in 2014 were investigated. Three-dimensional computed tomography
was performed for all cases. Area classification, choice of internal fixator, and
clinical results were compared. In area classification, the proximal femur was
divided into 4 areas with 3 lines: Line 1, centre of the neck; Line 2, border
between neck and trochanteric zone; and Line 3, linking inferior borders of the
greater and lesser trochanters. A fracture only in area 1 was classified as type 1;
a fracture in areas 1 and 2 was classified as type 1-2, etc.
Results: Type classification was type 3 in 30%, type 2-3 in 13%, type
3-4 in 13%, and type 2-3-4 in 4%. In type 2-3 fractures fixed using a single rag
screw, results were not good in 10.9%. However, all type 2-3 fractures fixed by
double rag screws showed good results. Long nails were used for only 1% of type 3
fractures, but 42% of type 3-4 fractures.
Conclusions: Area classification can classify when fractures exceed
particular zones of other classifications. A double rag screw device should be
considered for type 2-3, and long nails should be considered for type 3-4.
OP20-390 BIPOLAR HEMIARTHROPLASTY OR SCREW FIXATION AFTER FEMORAL NECK
FRACTURE. WHAT IS THE BEST OPTION FOR OUR PATIENT IN THE MIDTERM?
Arraiz-Diaz C, Fernandez E, Limousin B, Marin-Pena O,
Brañas-Baztan F, Larrainzar R
University Hospital Infanta Leonor, Madrid, Spain
Introduction/objectives: Bipolar Hemiarthroplasty (BH) or screw
fixations (SF) are good options to treat femoral neck fractures. Aim: Analyse the
physical function and mortality of patients treated with either BH or SF beyond 3
years after surgery.
Methods: We performed a retrospective study of 133 patients with femoral
neck fracture. 72 were treated with BH (Zimmer Versys) and 61 with SF between
2009-2012. We evaluated mortality, physical function using Functional Ambulation
Classification (FAC) and complications. SPSS 13.0 software was used for statistical
data analysis. Chi Square and non-parametric tests were used.
Results: Of the 133 patients, 76% were women. The mean age was 82.2
years in BH group and 73.2 years in SF group. The overall mortality at 4.6 years of
follow-up was 47.2% in group BH and 22.9% in group SF. The FAC score decrease from
4.51 pre-fracture to 3.67 points at final follow up in the BH group. 56% of patients
had same pre-operative FAC score, and 20% decrease in one point. In the SF group,
FAC score decrease from 4.71 pre-fracture to 3.87 points. 65% of patients had same
pre-operative FAC score, and 15% decrease in one point. Complications: In BH group,
26.6% had groin pain and two patients required new surgery (2.8%). In SF group, 18%
required new surgery, 5 patients need hemiarthroplasty and 6 patients need screw
removal.
Conclusions: Functional outcome was similar to pre-operative status
beyond three years, either with BH or SF. Mortality beyond three years was higher in
BH (47.2%) vs. SF (22.9%). New surgical treatment was higher in SF group (18%) vs.
BH (2.8%).
OP20-226 A NOVEL FRACTURE MECHANICS MODEL FOR OSTEOPOROTIC BONE: ENABLING THE
DESIGN OF SAFER AND MORE EFFECTIVE ORTHOPAEDIC IMPLANTS FOR ELDERLY
PATIENTS
Kulper S, Fang C, Lu W, Leung F, Ngan A, Sze
K
The University of Hong Kong, Pok Fu Lam, Hong Kong
Introduction/objectives: The fracture behaviour of porous and highly
compressible material in general remains an open area of research in the field of
solid mechanics. As a result, typical implants fail at high rates in elderly
patients, leading to complications such as “cut out,” in which implants penetrate
through bone into surrounding tissues of the shoulder and hip.
Methods: Femoral heads from human cadavers (15 matched pairs, female,
median age 75 years), and synthetic bone tissue (Sawbones, 0.16 g/cc) were analysed
for density and defects. Typical 5 mm screws for femoral and humeral neck fixation
were implanted along with several blunt and conical tip designs. Each screw was
pushed into the substrate axially at a constant penetration rate of 5 mm/min.
Micro-CT scans were repeated for each sample to observe fracture and compaction
patterns. Screws were then sawn in half axially, along with fresh substrates and
clamped between transparent slides, creating a “window” view. Each half-screw was
recorded during penetration and the video analysed using digital image correlation
(DIC) software to create a strain field.
Results: Load was recorded over 2 minutes, generating the following mean
values at 10 mm depth for 5 mm diameter screws: 161 N sharp tip; 112 N blunt tip;
130 N hemispherical tip (p<0.01). This empirical data was used to validate a new
mathematical osteoporotic bone fracture model based on the energy absorption
mechanisms of crack creation and material compaction.
Conclusions: Implants with so-called “anti-cutout” blunt tips may in
fact lead to increased cutout rates for osteoporotic patients in comparison to other
tip designs. We offer alternative design concepts that may lead to superior safety
and efficacy for implants intended for such patients.
OP20-399 A NEW MINI-INVASIVE NECK LENGTH PRESERVING DEVICE IN THE FIXATION OF
PERTROCHANTERIC FEMORAL FRACTURES
Massin P
Hopital Bichat Claude Bernard, Paris Cedex 18, France
Introduction/objectives: Dynamic fixation of extracapsular fractures of
the upper femur allowed compression at fracture site, accelerated healing and early
weight bearing. However, it was often associated with substantial neck shortening.
Quality of life scores showed that neck collapse impaired hip function. Therefore we
propose a new neck length preserving device.
Methods: Closed reduction is followed by percutaneous insertion of a
cervical screw, looking for inferior neck contact, head centre purchase and minimal
tip apex distance. A rectangular slotted intra-medullary blade is then inserted
through the perforated cervical screw, achieving a self-locking diaphyseal press
fit. A second smaller screw is finally inserted within the initial hollow cervical
screw, providing intraoperative compression and rigid connection between the blade
and the cervical screw. We hereby report the first 40 cases. Average patient's age
was 87 ± 9 years (30 females and 10 males). ASA stages were 2 in 14 patients, 3 in
20 patients and 4 in 6 patients. Except 8 who died, other patients were followed 6
months. Fractures were classified A1 in 14 cases, A2 in 24 cases and A3 in 2 cases.
A special radiographic protocol allowed measuring neck shortening and/or screw
cut-off.
Results: The 6-month mortality rate was 20%. In survivors, fractures
healed uneventfully. Neck length was preserved. Loss of Parker score was substantial
(30 ± 10%). Blood loss according to Mercuriali and Inghilerri was 200 ml ± 50.
Transfusions were required in 30% of patients.
Conclusions: Although results mainly relied on medical parameters, there
was an absence of cut-off or neck collapse despite a high rate of unstable
fractures.
OP20-43 THE CLINICAL USE OF A NEW DEVICE FOR OSTEOSYNTHESIS OF THE MEDIAL
FEMORAL NECK FRACTURES
Pyrohov E
Municipal Institution, Melitopol, Ukraine
Introduction/objectives: Every year marked increase in the proportion of
femoral neck fractures in the structure of injuries, due to the increase in the
number of elderly. Existing methods of osteosynthesis cannot provide good outcomes
in most of the patients with medial femoral neck fractures. To improve the results
of osteosynthesis of the medial femoral neck fractures.
Methods: Developed and put into practice a new device for medial femoral
neck fracture fixation. Proposed device due to its design features allows you to
create a primary compression between the fragments during the operation and the
secondary - due to the potential energy of the compressed spring. The special
ratchet mechanism provides unidirectional telescoping effect and the impossibility
of forming diastasis between the fragments that can achieve spontaneous fracture
stabilization in the postoperative period, even with substantial resorption of bone
fragments. Between February 2011 and July 2015 by the developed technique with the
proposed device done 115 surgeries in 114 patients aged 23 to 92 years.
Results: Clinical testing of the proposed device yielded 89.5% of
positive results and reduced the rate of complications by 39.5% in the main clinical
group.
Conclusions: The proposed device is justified in terms of anatomical and
clinical aspects, and the concept of resorptive process of bone fragments. Minimally
invasive osteosynthesis technique demonstrated effectiveness, including in
unfavorable for fusion medial fractures of the femoral neck in patients of different
age groups. The findings create the preconditions for the expansion of the
indications for conserving surgery among elderly patients and patients with
comorbidities.
OP20-15 CAN ORTHOPEDIC SURGEONS HELP CREATE A BETTER HEAD START FOR
OSTEOPOROSIS TREATMENT AFTER HIP FRACTURE?
Rinat B, Rubin G, Orbach H, Giwnewer U, Rozen
N
Haemek Medical Centre, Afula, Israel
Introduction/objectives: Treatment for osteoporosis in the community in
patients who were operated for hip fracture appears to be sub-optimal at most.
Evidence regarding treatment beyond the first year after surgery seems to be
scarce.
Methods: A retrospective observational cohort study in patients aged
50-90 years operated for osteoporotic hip fracture between the years 2008-2014. We
investigated the correlation between discharge recommendations and rates of
osteoporosis treatment one year post discharge and after and the influence of
osteoporosis diagnosis upon treatment.
Results: A total of 602 patients' files were examined. A univariate
analysis shows that out of 283 who were prescribed with dietary supplementation of
vitamin D and calcium significantly higher percentage of patients received treatment
if they had a recommendation (50.3% vs. 36.1%, p = 0.0005), were diagnosed (43.8%
vs. 14.4%, p<0.0001) or were of female gender (84.1% vs. 57.3%, p<0.0001).
Multivariate analysis shows that odds ratio for receiving treatment compared with
control group (those without a recommendation and a diagnosis) was higher among
patient who had both a recommendation and a treatment (OR = 5.4, p<0.0001), than
the group with diagnosis only (OR = 4.75, P<0.0001) or recommendation only (OR =
2.06, p = 0.0006).
Conclusions: Recommendations for osteoporosis treatment in the discharge
letter in patients who suffered osteoporotic hip fracture increase the rate of
treatment in the community. Patients who have both a recommendation and a diagnosis
for osteoporosis on their medical files have the highest chance of receiving
treatment in the community. Our observations may assist in amplifying the overall
treatment rates, which are still undoubtedly low.
OP21 Imaging
OP21-385 FIRST EXPERIENCES AND ONE YEAR EBRA RESULTS WITH INNOVATIVE SHORT
STEM
Maurer-Ertl W, Friesenbichler J, Maier M,
Bratschitsch G, Holzer L, Leithner A
Department of Orthopaedic Surgery, Medical University of Graz, Graz, Austria
Introduction/objectives: Almost 30 years after the introduction of the
Mayo short stem on the market, there is still an increasing interest in short stem
systems.
Although many implants have already been pulled from the market, the established
designs could offer advantages within proper indication. Since 2014, The
Optimys® short stem system is going to be evaluated at our
department.
Methods: In this prospective study, 60 patients with 62 prostheses were
included. Thirty-three male and 27 female patients were treated with the
Optimys® short stem system (Mathys, Swiss). The mean age at the time
of surgery was 63 years. The clinical and radiological follow-up included plain
radiographs and measurements of leg length discrepancy, cup inclination, offset and
the assessment of implant position. The stem migration was measured by
Ein-Bild-Röntgen-Anaylse (EBRA).
Results: All patients were treated with a ceramic-on-ceramic bearing.
The average difference in leg length was 4.2 mm pre-operatively and changed
postoperatively to 3.9 mm. Nearly half of the male patients (48%) were treated with
the stem sizes 6 (n = 7) and 7 (n = 6). Nearly three-quarters of the female patients
(72%) were treated with the sizes 4 (40%) and 5 (32%).
Results of EBRA: in 40% of all patients, the observed stem migration was
between 0.0 and 1.0 mm after 1 year, in 6.5% the stem migration exceeded 2.0 mm
(only 1 case with more than 3.0 mm). The average stem migration was 0.7 mm after 3
months, after 6 months 0.9 mm and 1.3 mm after 12 months, respectively.
Conclusions: First experiences and annual results for the
Optimys® short stem were very satisfying. We could prove a high
planning accuracy, a bone- and muscle-sparing surgical technique as well as good and
stable osseous integration with high patient satisfaction.
OP21-217 ROENTGEN STEREOPHOTOGRAMMETRY ANALYSIS (RSA) OF THE BONEMASTER COATED
TAPERLOC COMPARED WITH THE POROUS COATED TAPERLOC STEM (5 YEAR FU)
Keizer S1, Koster L2, Thomassen
B1
1MCHaaglanden-Bronovo, Orthopaedic Department, Den Haag, The Netherlands;
2Leiden University Centre, Orthopaedic Department, Leiden, The
Netherlands
Introduction/objectives: The uncemented porous coated Taperloc stem is a
successful femoral stem. The development of alternative coatings with advantages in
bone remodelling and transport of bone-active substances could influence the results
of an uncemented THA. We investigated the stability of an electrochemically
deposited hydroxyapatite (Bonemaster) Taperloc stem (BM). Our hypothesis was that
the Taperloc stem with the new BM coating would not be inferior to the conventional
Taperloc stem (cT).
Methods: Patients with osteoarthritis or avascular necrosis<66 years
of age, who were scheduled for a THA were included in this randomized controlled
study with two groups (BM and cT group). Clinical outcomes were measured using the
Harris Hip Score, the HOOS questionnaire and the SF12 pre-operatively and 3, 6
months and 1, 2 and 5 years after surgery. Furthermore, RSA radiographs were taken
at these moments.
Results: Thirty-one patients (32 hips) were included, 15 patients were
randomized to the cT group, 17 patients to the BM group. Mean age of all patients
was 58.8 (±5.7) years, mean BMI was 28.1 (±5.5). No significant differences between
the BM group and the cT group regarding functional outcome, measured with HHS, HOOS
and SF12, were observed five years after surgery. The difference in subsidence
(Superior-Inferior Translation) was 0, 27 mm at 5 year FU that was also not
significant.
Conclusions: The Bonemaster coated stem does not appear to be inferior
to the porous coated stem regarding clinical results and micro motion after 5 years
follow-up.
OP21-219 ROENTGEN STEREOPHOTOGRAMMETRY ANALYSIS (RSA) OF A SHORT THA STEM
COMPARED WITH UNCEMENTED POROUS COATED TAPERLOC STEM, A TWO YEAR FOLLOW
UP
1MCHaaglanden-Bronovo, Orthopaedic Department, Den Haag, The Netherlands;
2Reinier de Graaf Hospital, Orthopaedic Department, Delft, The
Netherlands
Introduction/objectives: Cementless total hip arthroplasty (THA) has
good clinical results. As a result of the success and the ageing population, the
number of THA procedures has increased and also the burden of THA revision.
Therefore, the new shorter Global Tissue Sparing (GTS) stem® was
developed to maintain of bone stock. In this study we performed a comparative
assessment between the clinical and radiographic outcomes (as measured with (RSA))
of the GTS stem compared to the Taperloc stem over a period of 2 year.
Methods: This multicentre randomized controlled trial included patients
with osteoarthritis or avascular necrosis <70 years of age, who were scheduled
for THA. Patients were randomized between the GTS® or
Taperloc® stem (Zimmer Biomet. Clinical outcomes were measured using
the HHS, the HOOS questionnaire and the EQ5D pre-operatively and 3, 6, 12 and 24
months after surgery. Furthermore, RSA radiographs were taken at these moments.
Results: 51 patients were included in the study. 26 patients were
randomized to a GTS® stem and 25 patients to a Taperloc stem. One patient
was lost to follow up. Mean age of all patients was 62.1 (±4.7), mean BMI was 25.3
(±3.6). No differences between both groups were observed regarding HHS, HOOS and
EQ5D two year after surgery. Migration along the medial-lateral axis of the stem was
significantly different. Median migration of the Taperloc stem was −0.14 mm and
median migration of the GTS stem was 0.082 mm. Other migration parameters did not
differ between both groups.
Conclusions: No significant differences between the GTS® and
the Taperloc® stem regarding functional outcome were observed at two
year. Migration along the medial-lateral axis differed significantly after two year,
in which the GTS stem was more stable.
OP21-179 X-RAY IMAGING OF ACETABULAR SHELLS: DO RADIOLUCENT LINES ALWAYS
CORRELATE TO PHYSICAL GAP?
Nevelos J, Faizan A, Chuang P, Aponte C
Stryker Orthopaedics, Mahwah, USA
Introduction/objectives: In general, a well-fixed cup shows no gaps or
radiolucency around the cup's outer diameter. However, sometimes these lucencies are
seen around clinically successful implants with 3D surfaces.
Methods: Six human cadavers were bilaterally implanted with acetabular
shells by an orthopaedic surgeon. 2D surface shells (Trident, Stryker) and 3D
surface shells (Tritanium, Stryker) were randomized between the left and right
acetabula. The surgeon used his regular surgical technique (1 mm under reaming). The
cadavers were sent for X-ray imaging after the operation. Following the X-ray
imaging, the acetabular shells were carefully resected from the cadavers. The
acetabular shells with the surrounding bone were fixed in 70% isopropyl alcohol for
about a week and subsequently embedded in polymethylmethacrylate.
The embedded shells were sectioned at 30° intervals using a diamond saw in the
coronal plane.
Results: The AP X-rays of the cadavers demonstrated radiolucent lines,
as well as gap defects in some cases. The same phenomenon was observed on the
contact X-rays of the embedded implant sections as well, where one could easily
identify the gap between the metal shell and the surrounding bone. The most striking
finding was that, in a few cases, the contact X-rays showed radiolucency around the
metal shell whereas the physical section did not seem to have any gaps. This was
visible in the 3D shell group.
Conclusions: We found radiolucency in the 3D shell group that was not
associated with the presence of a physical gap. It may be due to the presence of
low-density bone in the area that is not visible on the contact X-ray image, giving
an illusion of a gap. The contact X-ray images demonstrated that radiolucency around
shells may not always correlate with physical gaps.
OP21-134 IMPROVING ACETABULAR COMPONENT INCLINATION IN TOTAL HIP ARTHROPLASTY
BY USING A DIGITAL PROTRACTOR
Meermans G, Van Doorn J, Kats J-J
Bravis Hospital, Bergen op Zoom, The Netherlands
Introduction/objectives: In total hip arthroplasty (THA), a high
radiographic inclination angle (RI) of the cup should be avoided. The goal of this
study was to determine how accurate a surgeon could obtain the target operative
inclination (OI) and RI during THA using a digital protractor.
Methods: In this prospective study, we included 200 consecutive patients
undergoing uncemented primary THA. Pre-Operatively, the surgeon determined the
target OI (OIt) based on the patient's hip circumference (25°/27.5°/30°/32.5°).
Intraoperatively, the effective OI (OIe) was measured with the aid of a digital
protractor. The RI was measured on an anteroposterior pelvic radiograph by two
evaluators, blinded to the OIe. The safe zone for RI was defined as 30°-45° of
inclination.
Results: The mean difference between OIt and OIe was −0.7° SD 1.4. This
difference was less than 1° in 108 patients (54%), less than 2° in 160 patients
(80%) and less than 3° in 186 patients (93%). The mean RI was 37.9° SD 4.7. The mean
difference between the RI and OIe was 11.5° SD 4.7. Overall, 188 cups (94%) were
within the inclination safe zone. When analysing the RI outliers, 2 could have been
avoided if the difference between OIt and OIe would have been smaller. For the
remaining 10 outliers the difference between the RI and OIe was in the upper and
lower 7th percentile, indicating more or less than average motion of the
pelvis in these patients.
Conclusions: The use of a digital protractor allows surgeons to
accurately implant the acetabular component in the desired OI. By adjusting the
target OI based on the patient's hip circumference, 94% of the acetabular components
were placed within an inclination safe zone of 30°-45°. Most outliers were caused by
more of less than average intraoperative pelvic motion.
OP21-383 VALIDITY OF THR PLANNING 3D VERSUS 2D SOFTWARE FOR USING A NOVEL
SHORT STEM
1Department of Orthopaedic Surgery, Medical University of Graz, Graz,
Austria; 2Department of Orthopaedic Surgery, Krankenhaus der Barmherzigen
Brüder Eisenstadt, Eisenstadt, Austria
Introduction/objectives: The demand for the restoration of a functional
and physiological geometry following implantation of a total hip replacement is
increasingly expected. In former times, the “butter paper” planning has gone out of
use and the age of the digital 2D planning was introduced, routinely. The aim of the
current study was to evaluate and compare the validity of the two planning
modalities.
Methods: In this prospective study of 70 patients, pre- and
postoperative low dose rotational CT examinations of the hip are performed for data
analysis during an ongoing study investigating on the performance of the short stem
Proxy® (Implantec, Austria). In addition to the 2D planning on
conventional radiographs, a 3D planning was made, measured and the pre-operative
planning accuracy was analysed.
Results: The average leg length difference in the 2D planning was
pre-operatively 10.1 mm and decreased postoperatively to 3.9 mm. The femoral offset
changed from pre- to postoperative in the mean of 7 mm. In comparison between
planned and actually implanted stem size using 2D software in 52.4% conformed, in
42.9% a femoral stem one size bigger or smaller was used as planned. In the 3D
planning the average leg length difference was pre-operatively 17.36 mm and
decreased postoperatively to 4.5 mm. The femoral offset changed from pre- to
post-operatively to an average of 3.1 mm. Using 3D software the implanted stem
conformed in 84.8%, in 15.2% a stem size bigger or smaller was used as planned.
Conclusions: The 3D software provides a more accurate pre-operative
planning ability compared to the 2D variant but is also associated with
significantly more effort. Furthermore, an increased exposure to radiation from the
required 3D rotational CT has to be considered.
OP21-186 ASSESSMENT OF THE RELATIONSHIP BETWEEN PELVIC TILT AND FUNCTIONAL
ACETABULAR POSITION AFTER TOTAL HIP ARTHROPLASTY WITH EOS 2D/3D
TECHNOLOGY
Loppini M, Astore F, Caldarella E, Della Rocca A,
Della Rocca F, Ricci D, Grappiolo G
Humanitas Research Hospital, Rozzano, Milan, Italy
Introduction/objectives: Functional orientation of the pelvis is related
to spine sagittal balance and affects the cup orientation after total hip
arthroplasty (THA). Sacral slope (SS), rather than the anterior pelvic plane angle
(APPA), could represent the actual pelvic orientation. We investigated the variation
of pelvic tilt (PT) after THA, the relationship between APPA and SS, and the
relationships of APPA and SS with acetabular inclination (AI) and anteversion
(AA).
Methods: We prospectively enrolled 50 consecutive patients (M:F = 28:22)
who underwent EOS 2D/3D radiography in standing and sitting positions before and 3
months after THA. 3D images were patient-specific and took into account orientation
of the spine and pelvis measuring PT, APPA and SS before and after surgery. In
postoperative 3D images, values of AA and AI were also measured.
Results: Standing PT significantly increased after surgery (P = 0.03),
but less than 3°. No significant difference was found after surgery in sitting PT,
standing and sitting APPA and SS. No relationship was found between values of APPA
and SS before and after surgery in both positions. Changes of SS between standing
and sitting position correlated with changes of AA (r = −0.61; P<0.0001; R2 =
0.55). No correlation was found between changes of APPA with changes of AA and
AI.
Conclusions: Pelvic parameters do not significantly change after THA.
Because of APPA changes do not correlate with pelvic orientation changes, and only
SS values are significantly correlated with cup orientation, functional cup
orientation should be pre-operatively planned basing on SS, rather than APPA. Future
navigation systems should include the SS parameter for each patient.
OP22 Trauma 2
OP22-108 SURGICAL TREATMENT FOR PERIPROSTATIC FRACTURE AROUND HIP
ARTHROPLASTY
Yo H, Ohashi H, Sugama R, Ikawa T
Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
Introduction/objectives: Periprosthetic fractures of the femur are a
serious complication of total hip arthroplasty (THA) that pose a big challenge to
Wreconstructive orthopaedic surgeons. The treatment strategies depend on the nature
of a fracture, implant stability, bone-stock quality, patient age and surgeon's
experience.
The aim of this study was to evaluate treatment methods with respect to stem revision
and osteosynthesis.
Methods: 23 periprosthetic fractures after THA were treated in our
hospital. There were 3 men and 20 women. The average patient age was 80.6 years. 9
fractures were classified as Vancouver type B1, 4 as type B2, 3 as type B3, and 7 as
type C. The way of treatment, the percentage of united fractures, and the stability
of the implants were investigated.
Results: Type B1 and type C fractures were fixed with a locking plate.
In type B2 and B3 fractures, 3 fractures were treated with a cementless modular
tapered revision femoral component, one was treated with a Huckstep hip, and one was
treated with a cemented long stem fixed by impaction bone grafting. After the
average follow-up period of 51.9 months, complete fracture union occurred in 22 of
the 23 cases (93.3%). In one case in type B1 fracture, stem subsidence was occurred
and required stem revision. The case was classified as B1 at first, because of the
result of osteosynthesis, this case was finally classified as B2.
Conclusions: Besides the Vancouver classification, bone-stock quality,
patient age, patient's level of physical activity should be considered to select the
treatment.
In conclusion, our treatment for the periprosthetic fractures after THA showed
favourable outcome.
OP22-157 REDUCED MORTALITY USING ORIF IN PERIPROSTHETIC VANCOUVER B1/2 AND C
FRACTURES
Stark M, Schuler M, Ortner F
Unfallchirurgie Schwerpunktkrankenhaus Wiener Neustadt, Wiener Neustadt, Austria
Introduction/objectives: The recommended treatment for Vancover B2 and
B3 fractures is with revision hip arthroplasty (RHA). Regarding type B1 and C
fractures, ORIF is the treatment of choice. Data from literature show a high
mortality (14-17%) and complication rate (14.3%). The aim was to show, that ORIF is
a stable and safe treatment for Vancouver B1/B2/C fractures with a lower mortality
rate compared to RHA.
Methods: We conducted a retrospective data analysis of our own patient
collective with periprosthetic hip fractures in a 5 year period. Included were all
patients with Vancouver B1/2 and C fractures which have been treated with ORIF. The
dates were analysed with SPSS 17.0. The hypothesis were tested with the
chi2-test.
Results: 83 patients from 2011-2015 were included. 2/3 were female, 1/3
male, the average age was 75.1 years. 73.5% of the fractures were classified as
Vancouver B1/B2 and 26, 5% as Vancouver C. Mechanical complications like
implant-failure or non-union occurred in 8% in one year time. 87% were treated with
LC-plating and cerclages with an average time of non-weight bearing mobilization of
7.1 weeks. 2/3 of the patients did not need any transfusion of EC, while the other
1/3 did not need more than 2 EC. Early complication rate ranged at 23%, which is
higher than comparable data from literature. Mortality on the other hand was 4.8%
and as such lower than published rates.
Conclusions: ORIF with LC plating and cerclages is a stable and gentle
method with a reduced mortality. The low need for transfusions also points to this
procedure as less invasive. It was also shown by the low rate of mechanical failure,
that Vancouver B2 fractures could be treated safely with ORIF. The indication for
RHA as treatment of these fractures might have to be discussed.
OP22-240 IS ARTHROPLASTY INDICATED IN THE TREATMENT OF EXTRA CAPSULAR
FRACTURES OF THE UPPER FEMUR IN THE ELDERLY?
Massin P1, Duriez P2, Chantelot
C2, Devaux T2
1Hopital Bichat Claude Bernard, Paris Cedex 18, France;
2Hôpîtaux Universitaires de Lille, Lille, France
Introduction/objectives: We investigated if hip arthroplasty was
justified in extra capsular fractures over 80 years of age.
Methods: A prospective multicentre trial was undertaken. Care was taken
not modifying surgeons' habits. 701 patients over 80 years (mean 88 ± 5) were
included (351 A1, 326 A2 and 60 A3). Patients were assessed for nutritional state,
walking abilities according to Parker and dependence according to Katz
pre-operatively and 6 months following the surgical treatment. 521 underwent
fixation while 176 had an arthroplasty.
Multivariate analysis was performed to determine the effect of several parameters on
mortality, morbidity and functional results Results: Mortality was
higher in the arthroplasty group (25%) compared to fixation (17%, p = 0.02). Blood
losses were also more important (425 ± 286 versus 333 ± 223, p<0.0001).
Transfusions were more frequent (61% in arthroplasty versus 32% in fixation group,
p<0.0001). Infections were more frequent in the arthroplasty group (4% versus
0.2%, p<0.001).
Multivariate analysis showed that pre-operative Parker score and ASA grade
independently influenced mortality. Mortality was higher in women and in obese
patients. A poor pre-operative nutritional state and a long delay to surgery
significantly increased mortality. The type of treatment did not influence
functional results. 56% of patients lost autonomy and 44% became dependant.
Transfusions independently contributed to augment dependence and were associated
with mechanical complications.
Conclusions: Arthroplasty appears not indicated in extra capsular
fractures. Results were more related to the patient's pre-operative physical and
nutritional states. This pleads for specialized geriatric units.
OP22-422 COMBINATION OF RISK FACTORS AS AN INDICATION FOR TOTAL HIP
ARTHROPLASTY IN TRANSACETABULAR FRACTURES
Voloshin V, Galkin A, Sankaranarayanan Arumugam
S
Moscow Regional Clinical and Research Institute, Moscow, Russian Federation
Introduction/objectives: Analysing combination of risk factors as an
indication for THA in transacetabular fractures.
Methods: From 2005 to 2014, 160 operations (84 osteosynthesis, 76 THA)
were performed in 131 patients (aged 17-76 years) with transacetabular fractures.
Clinical results were evaluated by Harris Hip Score. 27 patients underwent
osteosynthesis and THA at one setting (Group1). In the 2nd group, 20
patients initially got conservative treatment. Later THA was needed in these
patients due to undesirable outcome. 29 patients underwent osteosynthesis initially,
later THA was needed due to avascular necrosis of femoral head or post traumatic
arthritis (Group3).
Results: The following risk factors are considered. 1. From the time of
injury to surgery is more than 3 weeks; 2. Comminuted fracture of the acetabulum; 3.
Combined damage to the posterior border of acetabulum; 4. Age over 45 years. 55 of
84 got satisfactory result after osteosynthesis. Good or satisfactory results were
obtained in 16 patients, who had 3 negative factors (<45 years). 13 (81.25%) out
of 29 patients (>45 years), had unsatisfactory outcome after osteosynthesis. 16
(23.5%) patients out of 68 (<45 years), required THA. Patients with two negative
factors, THA was required in 50% of cases in both age groups. THA was needed in the
first 2 years for the patients aged >45 years. For patients<45 years, THA was
needed after 3.5-11 years from the time of osteosynthesis. The Harris Hip Score for
1st, 2nd and the 3rd groups were 86, 88 and 85
respectively.
Conclusions: The age of the patient is the most important negative
factor. In the first 2 years, 80% of unsatisfactory results were obtained in the
group older than 45 years. May be, doing primary THA will be the rational way of
treating these patients.
OP22-203 SURGICAL HIP DISLOCATION; INCREASING INDICATIONS IN ACETABULAR
FRACTURES
Abdelnasser MK, Farouk O, Elrefai O, Badran M,
Fergani A
Assuit University Hospital, Assuit, Egypt
Introduction/objectives: Anatomical reduction is essential for the
outcome of acetabular fractures. Surgical hip dislocation has been described as an
excellent method for reduction and fixation of acetabular fractures. The aims of the
study are to describe the extended indications of surgical hip dislocation in
acetabular fractures, and to discuss techniques of reduction, early complications,
and results.
Methods: Between July 2013 and September 2015, we used surgical hip
dislocation in 27 cases of acetabular fractures. The indications were roof impaction
(25.9%), roof displacement (7.4%), associated femoral head fracture (18.5%),
inaccessible intraarticular fragment (7.4%), reduction of the anterior column in T
and transverse fractures (18.5%), pure impaction injury (3.7%), entrapped posterior
wall (11.1%), and traumatic bony avulsion of the labrum (7.4%). Different techniques
of reductions were used. Clinical Outcomes were evaluated with both the modified
Merle d'Aubigne' and Harris hip Score. Radiographic outcome was scored according to
Matta's criteria on postoperative and follow-up radiographs.
Results: The average follow-up was 18 months (6 to 33 months).
Anatomical reduction was obtained in 91.7%, and satisfactory in 8.7% of cases. The
clinical scores were excellent in 28.5%, good in 42.8%, fair in 14.2%, and poor in
14.2% of cases. 2 cases eventually needed THR. One case developed AVN 8 months after
surgery. One patient developed severe Heterotopic ossification.
Conclusions: Surgical hip dislocation offers many advantages in
acetabular fractures; it allows direct assessment of cartilaginous injury, easy
dealing with incarcerated fragments and femoral head fracture, and obviates the need
for a second approach. It ensures anatomical reduction with a low complication
risk.
OP22-129 TOTAL HIP ARTHROPLASTY IN PATIENT WITH MISSED POSTERIOR WALL
FRACTURES
Aminjavaheri S, Mortazavi SMJ, Mostafavi Tabatabaee
R
Tehran University of Medical Science, Joint Reconstruction Research Centre, Tehran,
Islamic Republic of Iran
Introduction/objectives: Total hip arthroplasty (THA) in patients with
missed posterior wall fractures represents a rare and challenging scenario for joint
surgeons. There are many reports on THA following acetabular fractures treated by
internal fixation; however, there are few previous reports on THA following missed
posterior wall fracture.
Methods: 7 patients (mean age: 42) with untreated posterior wall
fracture of the acetabulum, presented to our institution with severe osteoarthritis
5 months after primary trauma. There were 5 pure posterior wall fractures and 2
posterior wall and column fractures. We decided to put the cup in a little higher
center rather than reconstruct the posterior wall. All cases were done with the
lateral approach in supine position. All patients were ambulated on the day after
surgery with weight bearing as tolerated program. We did not apply hip precautions
to these patients.
Results: We placed acetabular implants within 8-18 mm upward from the
tear drop (upward distance average 14/4 mm). Postoperatively, the function of hip
joints improved with HHS rising from 42.5 ± 6.42 to 88.3 ± 7.27 after 1 year, which
was significantly different (P<0.05). At the latest follow up (mean: 45 months),
radiographic assessment showed satisfactory cup position with bone ingrowth and no
signs of loosening.
Conclusions: Putting acetabular cup in a higher but more supportive bone
offers a reliable and easier technique for reconstruction acetabular posterior wall
deficiencies.
OP22-331 IS THERE A DIFFERENCE IN EARLY OUTCOME OR COMPLICATION RATE BETWEEN
HIGH-VOLUME VERSUS LOW-VOLUME SURGEONS IN HIP HEMIARTHROPLASTY?
Spaans E1, Wagenmakers R1, van
den Hout J1, Koenraadt K2, Elmans L1, Bolder
S1
1Amphia Hospital, Breda, The Netherlands; 2Amphia Hospital,
Foundation for Orthopaedic Research, Care and Education, Breda, The Netherlands
Introduction/objectives: Volume of hip arthroplasties annually per
surgeon is of importance with regard to revision rates in THA, particularly within
the first 6-18 months postoperatively. We retrospectively analysed
hemiarthroplasties placed by low-volume and high-volume surgeons, focusing on early
survival and complications.
Methods: Between March 2009 and January 2014 we performed 759
hemiarthroplasties for intracapsular femoral neck fracture by 33 surgeons. We
divided the surgeons in low-volume (n = 26) and high volume surgeons (n = 7). The
low-volume group only performed hemiarthroplasties and did less than 25 hip
arthroplasties annually. The high-volume group performed both hemiarthroplasties and
elective THA and did more than 50 hip arthroplasties annually. Primary outcome was
stem survival at 6, 12 and 18 months and at 5 years. Log-rank test was used to
compare survival. Fisher's exact tests were used to compare the rate of dislocation,
fracture and infection.
Results: 311 hemiarthroplasties were placed by low-volume surgeons and
448 were placed by high-volume surgeons. Mean age at time of surgery was 84
(45-101). Survival rates at 6, 12 and 18 months were 95.9%, 95.0% and 94.5% for the
low-volume group and 96.3%, 95.6% and 95.3% for the high-volume group. This was not
significantly different (p = 0.44, 0.38, 0.35). Survival rates at 5 years were 93.2%
and 93.4% respectively (p = 0.67). We did not find a difference in dislocation rate
(4.2 vs 3.6%, p = 0.7), fracture rate (4.2% and 3.9%, p = 0.9) or infection rate
(3.2% vs 4.0, p = 0.7).
Conclusions: We did not find any statistically significant differences
in early outcome and complication rate. Hemiarthroplasty can safely be performed
both by experienced hip surgeons and low-volume surgeons.
ePOSTERS WITH ORAL PRESENTATION
ePO1 Conservative Hip Surgery
ePO1-213 CERAMIC ON CERAMIC HIP ARTHROPLASTY WITH 36 MM FEMORAL HEADS IN YOUNG
PATIENTS
Pons M, Gaviria E
Servei de Cirurgia Ortopèdica, Hospital Sant Rafael, Barcelona, Spain
Introduction/objectives: Large ceramic femoral heads offer several
advantages including a reduction in instability and an improvement in the range of
movement (ROM).
The aim of our study was to analyse the ROM, stability and level of activity in
patients with ceramic on ceramic (CoC) bearings with 36 mm femoral heads.
Methods: We performed a retrospective study of 49 patients under 50
years old (56 hips in total) operated in our institution between 2009 and 2012. All
received a CFP stem and a Betacup or Combicup (Waldemar Link GMBH, Hamburg, Germany)
with a CoC Biolox Delta bearing and a 36 mm femoral head. The most frequently used
cups were 50 and 52 mm (the range was from 50 mm to 56 mm).
Results: We reviewed 45 patients (49 hips) with a minimum follow-up of 3
years. The average age was 46, 48 years old (range: 27-55). We found no dislocations
and a major improvement in ROM, mainly in flexion and abduction. 33 patients were
actively working and 29 practiced some sport. 27 had no problems with socks and
shoes and 36 were able to adopt a squatting position as an indicator of mobility. We
found 1 case of squeaking that disappeared after contralateral hip arthroplasty and
1 click for joint laxity. In one revision for acute haematogenous arthritis
following a urinary tract infection 5 years after surgery we found no stripe
wear.
Conclusions: We can implant 36 mm femoral heads in CoC bearings with 50
mm cups, which is the most common size together with 52 mm ones, among our patients.
(The 36 mm femoral head with a ceramic or polyethylene liner is only for cups from
54 mm upwards). Our study shows a great improvement in stability, level of activity
and ROM in our patients with a low incidence of complications.
ePO1-128 OUTCOME OF CORE DECOMPRESSION IN OSTEONECROSIS OF FEMORAL HEAD
Aminjavaheri S, Mortazavi SMJ
Tehran University of Medical Science, Joint Reconstruction Research Centre, Tehran,
Islamic Republic of Iran
Introduction/objectives: The treatment of adult avascular necrosis of
the femoral head remains a challenge. Risk factors include steroids, alcohol abuse,
chemotherapy and immunosuppressive medication but a genetic predisposition has been
suggested. Early diagnosis of this often bilateral disease process is essential for
successful joint preserving surgical management. Core decompression procedure in the
initial stages before collapse may arrest or reverse the progress of avascular
necrosis. We have analysed the clinical functional and radiological outcome of core
decompression in-patients with osteonecrosis of the femoral head up to stage IIB
(FicatAlert).
Methods: This study was undertaken at Emam Khomeini Hospital from March
2014 to Dec 2015 wherein 88 patients (160 hips) of ONFH up to stage IIB were treated
with core decompression and the outcomes were studied. Patients were subjected to
core decompression of the affected hip. All the patients were operated in supine
position under image intensifier guidance by DHS reamer.
Results: Functional outcome was assessed by Harris score. Wherein 112
hips (70%) had good or excellent outcome. 43 hips (25%) showed poor result and 5
hips (5%) had fair outcome. For stage I 94% and for stage IIA 60%, stage IIB 45%
showed improvement. Less than 15% of the hips required joint replacement.
Conclusions: Core decompression provide satisfactory outcome when
patients are carefully selected in early stages of the disease before the stage of
collapse.
ePO1-227 VALIDATION OF RADIAL CENTER EDGE ANGLE CALCULATED BY ACETABULAR
COVERAGE ANALYSIS SOFTWARE “ACX DYNAMICS”
Nishikino S, Koyama H, Nakamura H, Hoshino H,
Matsuyama Y
Handayama 1-20-1, Department of Orthopaedic Surgery, Hamamatsu, Japan
Introduction/objectives: ACX dynamic (ACX) software enables evaluation
of three dimensional acetabular coverage as radial centre angle (RCE) using a plain
antero-posterior (AP) radiograph of pelvis. RCE is defined by the angle formed by
two lines connecting the femoral head centre to the acetabular edge and the vertical
line through the femoral head on various radial planes. The purpose of this study
was to validate the accuracy of RCE calculated by ACX in comparison with images
obtained by computed tomography (CT).
Methods: We reviewed CT images from 30 hips (30 non-operative hip joints
with no osteoarthritic changes). Utilizing the software (Zed Hip, LEXI, Tokyo)
developed for THA pre-operative three-dimensional planning, digitally reconstructed
radiographic images (DRR) of the pelvis were then created. On coronal DRR
substituting as AP radiographs, RCE was semi-automatically evaluated by ACX. Using
CT images, RCE was also directly measured on each radial planes (every 15 degrees,
from anterior 0° (A0°: same as axial plane) to posterior 60° (P60°), AP90°: same as
coronal plane). We investigated the difference and the correlation between RCE by
ACX and that by CT image.
Results: The average differences (absolute value) were A0°: 10.3 ± 6.7°,
A15°: 6.1 ± 5.0°, A30°: 6.7 ± 5.6°, A45°: 4.7 ± 3.4°, A60°: 4.3 ± 3.0°, A75°: 3.0 ±
2.0°, AP90°: 3.6 ± 2.5°, P75°: 4.9 ± 2.9°, P60°: 7.8 ± 4.9°. A strong correlation of
the RCE measured by ACE and the CT images were observed on the radial planes from
A45° to P75° (r = 0.90-0.93).
Conclusions: RCE calculated by ACX showed the reasonable values on the
radial planes from A45° to P75°, which was clinically important to evaluate
acetabular morphology of the patients with dysplastic hip or pincer type FAI.
ePO1-21 THE VALIDITY AND ACCURACY OF MRI ARTHROGRAM IN THE DIAGNOSIS OF
PATHOLOGY OF THE HIP
Rajeev A1, Mohammed A2, Tumia
N2, Loughead J2
1Queen Elizabeth Hospital, Gatesheah Health NHS Trust, Gateshead, UK;
2Queen Elizabeth Hospital, Gateshead, UK
Introduction/objectives: The complex anatomy and biomechanics of the hip
makes the diagnosis of hip pathology very challenging. MRI arthrograms of the hip
have been used as a diagnostic tool to detect the pathologies of the hip joint. The
aim of our study is to find out the sensitivity, specificity and accuracy in the
diagnosis of various hip pathology.
Methods: A retrospective analysis of 113 patients who had MRI arthrogram
and who underwent hip arthroscopy were included in the study. The MRI arthrogram was
performed using gadolinium injection and reported by a single radiologist. The
findings were then compared to that found on arthroscopy. The sensitivity,
specificity, positive predictive value (PPV), negative predictive value (NPV),
accuracy and 95% confidence interval (CI) were calculated for each pathology.
Results: Labral tear-sensitivity 88.6%, specificity 43.8%, PPV 79.5%,
NPV 60.1%, accuracy 72% and CI 0.87-1.03. Delamination and chondral
changes-sensitivity 25%, specificity 78.6%, PPV 78.6%, NPV 25%, accuracy 38.9% and
CI 0.18-0.32. Femoral-acetabular impingement-sensitivity 30.8%, specificity 79.1%,
PPV 32.4%, NPV 67.9%, accuracy 61.1% and CI 0.22-0.38. Synovitis-sensitivity 15.4%,
specificity 98.8%, PPV 80%, NPV 79.4%, accuracy 78.8% and CI 0.03-0.33.
Conclusions: Our study showed that in addition to detecting the labral
tears, MRI arthrogram is helpful in the diagnosis of femoral-acetabular impingement
and synovitis. However when it comes to the diagnosis of chondral changes, defects
and cartilage delamination the sensitivity falls to 25% and accuracy to 39%. In the
diagnosis of cartilage pathology including delamination and chondral defects, hip
arthroscopy is superior to MRI arthrogram.
ePO1-337 TREATMENT OF HIP CHONDRAL DEFECTS WITH BONE MARROW STIMULATION AND
BST-CARGEL
Capurro B1, Tey M2, Mas
J3, Leon A1, Marques F1
1Hospital del Mar, Barcelona, Spain; 2Hospital del Mar,
Hospital Dexeus, Barcelona, Spain; 3Clinica Vistahermosa, Alicante,
Spain
Introduction/objectives: Articular cartilage lesions represent, after
labral lesions, the most common pathology found in patients undergoing hip
arthroscopy. Those are rarely unable to spontaneously self-repair and untreated
progression to more generalized degeneration will occur. Microfracture is the
standard of care for the treatment of limited chondral lesions in the hip joint, but
with highly variable clinical outcome. The application of BST-Cargel (R) in
combination with microfracture for the treatment of hip cartilage defects may be
considered a safe, cost-efficient therapeutic choice for the treatment of hip
chondral lesions.
Methods: A prospective study was conducted on 14 patients with hip
acetabulum chondral lesion treated with bone marrow stimulation in combination with
BST-Cargel between 2013 and 2014. Mean age at time of surgery was 42 years.
Quantitative Magnetic Resonance Imaging (dGEMRIC and T2 Mapping), x-ray articular
joint space, were evaluated and functionality was valued by using the de NAHS.
Results: The mean chondral defect size was 3 cm2. Chondral
lesions where associated to FAI in 85% of cases. Osteoplasty and labral repair was
performed in all FAI associated cases. At 2 years, the mean radiography articular
joint space was >2 mm in 92% of cases.
Quantitative MRI showed high values of repair tissue. Mean functional value was
Good.
Conclusions: Bone marrow stimulation technique in combination with
BST-Cargel may be considered a reliable therapeutic choice for treatment of chondral
lesions of the hip.
ePO1-449 OUTCOMES OF FEMORAL HEAD MARROW STIMULATION TECHNIQUES WITH MINIMUM
TWO YEAR FOLLOW-UP
Hartigan D, Perets I, Walsh J, Close M, Chaharbakhshi
E, Domb B
American Hip Institute, Westmont, USA
Introduction/objectives: The purpose of this study was to report the
greater than two year outcomes of patients who underwent hip arthroscopy and femoral
head marrow stimulation techniques for Outerbridge IV cartilage lesions.
Methods: This institution's database was searched for all femoral head
marrow stimulation procedures performed between February 2008 and September 2013.
Inclusion criteria were greater than two-year follow-up and femoral head marrow
stimulation technique performed at the time of arthroscopy. Exclusion criteria
consisted of revision surgery, dysplasia, Tönnis>1, protrusio or profunda
acetabula, Perthes, SCFE, abductor tears, or avascular necrosis of the hip. Outcomes
recorded were: visual analog scale (VAS), modified Harris hip score (mHHS),
non-arthritic hip score (NAHS), hip outcome score-activity of daily living subscale
(HOS-ADL) and sports specific subscale (HOS-SSS), and patient satisfaction. P
values<0.05 were considered statistically significant.
Results: There were fifteen patients that met all inclusion/exclusion
criteria. PRO improvements were all found to be statistically significant
(p<0.01) except HOS-ADL (p = 0.14). Average patient satisfaction was 7.36. Two
patients required THA, at 2 and 58 months, giving an 87% survivorship. No
correlation was found between size of the lesion and patient outcomes.
Conclusions: This study showed that patients with Outerbridge grade IV
cartilage lesions of the femoral head treated with marrow stimulation techniques had
significant improvement in VAS and all PROs except HOS-ADL. There are many technical
challenges that make femoral marrow stimulation techniques difficult and improved
instrumentation and techniques may alleviate some of these difficulties and perhaps
lead to improved outcomes.
ePO1-19 FEMOROACETABULAR IMPINGEMENT TREATMENT USING ANTERIOR MINI-OPEN
APPROACH, SHORT TERM RESULTS
Diranzo García J. Estrems Díaz V, Castillo Ruiperez
L, Hernández Ferrando L, Bru Pomer A
Consorcio Hospital General Universitario de Valencia, Valencia, Spain
Introduction/objectives: Femoroacetabular impingement (FAI) was recently
proposed to describe a range of abnormal anatomic relationships in the hip joint
that can produce an early osteoarthritis, especially in young and active patients.
FAI is produced by bone deformities or alterations in the femoral head orientation
or femoral head-neck junction (CAM), acetabulum (PINCER) or both.
Purpose of this work is to evaluate the clinical results in our first series of
patients with FAI treated with anterior mini-open approach at a minimum follow up of
1 year.
Methods: We have prospectively analysed 30 patients with FAI surgery by
anterior mini-open approach. 17 patients were men and 13 women. The mean age was 36
years. The mean follow up period was 18 months (12-36 months). 12 patients had CAM
impingement, 2 PINCER and 16 mixed impingement. All patients were evaluated with the
scales SF36, WOMAC and NAHS. Deformity correction and progression of the
osteoarthritis grade were evaluated too.
Results: The average score on the WOMAC scale increased from 55
pre-operatively to 76 at the last control (p<0.05). The NAHS score improved from
47 to 79 points (p<0.05). SF36 dimensions “physical functioning and bodily pain”
also increased by 26 (43 to 69) and 33 points (26 to 59) respectively (p<0.05). 5
patients developed a meralgia paresthetica that was resolved in less than a year.
One patient required prosthetic replacement for progression of his osteoarthritis.
One patient developed heterotopic ossifications.
Conclusions: FAI treatment by mini-open approach is a safe and
reproducible procedure. This technique allows correction of anatomical abnormalities
and obtains satisfactory clinical outcomes in a cohort of young patients, improving
their quality of life regarding to pain, mobility and function.
ePO1-9 FEMORAL NECK FRACTURE AFTER ARTHROSCOPIC FAI CAM SURGERY - CASE REPORT
OF A FEMALE PATIENT WITH A REVIEW OF LITERATURE
Sobau C1, Zimmerer A2
1ARCUS Sportklinik, Orthopädie und Unfallchirurgie, Pforzheim,
Germany;
2ARCUS Sportklinik, Pforzheim, Germany
Introduction/objectives: Hip arthroscopy has been established over the
past decade as a secure treatment for FAI surgery. Femoral neck fracture is a very
rare complication in hip arthroscopy treating FAI CAM.
Methods: We report the case of a 54-year-old female patient who suffered
a stress fracture of the femoral neck five weeks postoperatively after arthroscopic
femoral neck osteochondroplasty while a full weight bearing walk doing her normal
shopping. To our knowledge this is the first reported case of a female patient. She
presented herself at our office with severe groin pain, was unable to walk without
crutches but her passive range of motion was not impaired. A plain x-ray was normal,
but the MRI showed an incomplete femoral neck fracture. We put her back on crutches
with only touch weight bearing for 6 weeks. Consecutive MRI and x-ray showed no
fracture anymore.
Results: Hip arthroscopy has become a safe and successful method
treating FAI. In the literature the fracture rate in FAI CAM surgery is 0, 1-1.9%.
So far, there were only reports about male patients with femoral neck fractures
after arthroscopic offset correction. Some studies report risk factors for male
patients such as higher age, greater height or an increased resection-depth-ratio at
the femoral neck in male patients. Out of these risk factors for men our female
patient presents only an increased age with 54 years. Future studies should consider
negative prognostic factors for female patients differentiated from those of
men.
Conclusions: Postoperative groin pain after load increase should be
taken into consideration as a sign of a possible femoral neck stress fracture. With
an inconspicuous X-ray a MRI or CT diagnosis should be initiated. If a fracture is
diagnosed conservative treatment should be sufficient.
ePO1-439 CLINICAL OUTCOMES OF ILIOPSOAS FRACTIONAL LENGTHENING IN COMPETITIVE
ATHLETES UNDERGOING HIP ARTHROSCOPY - MINIMUM 2 YEAR FOLLOW-UP
1American Hip Institute, Westmont, USA; 2Hinsdale Orthopaedics,
American Hip Institute, Westmont, USA
Introduction/objectives: The iliopsoas is a hip flexor and stabilizer
that may be associated with internal snapping. Painful internal snapping may be
debilitating and may necessitate arthroscopic iliopsoas fractional lengthening
(IFL). Our purpose was to report minimum two-year results for athletes'
patient-reported outcomes (PROs), returning to sports, and competitive abilities
after IFL during hip arthroscopy.
Methods: Data were prospectively collected and retrospectively reviewed
for 1,682 patients undergoing hip arthroscopy between February 2008 and October
2013. Inclusion criteria were high school, collegiate, or professional athlete,
underwent arthroscopic IFL, and had pre-operative modified Harris Hip Score (mHHS),
Non-Arthritic Athletic Hip Score (NAHS), Hip Outcome Score - Sports Specific
Subscale (HOS-SSS), and Visual Analog Scale (VAS). Exclusion criteria were age
<16 years, Tönnis >1, previous hip conditions, hip dysplasia, and previous
surgical intervention for either hip.
Results: Forty-four of fifty athletes (88%) had minimum two-year
follow-up. PRO scores improved significantly (p<0.0001). Mean improvements were
as follows: mHHS (65.1-83.7), NAHS (60.7-86.2), HOS-SSS (41.5-75.4), VAS (5.8-2.0).
Mean satisfaction was 8.1. Internal snapping was resolved in 35 (80%) patients.
Three (6%) had unresolved painful snapping. Twenty-nine (65.9%) returned to sports,
and 24 (54.5%) maintained or improved their competitive abilities. Two (4.6%)
superficial wound infections resolved with topical treatment.
Conclusions: In competitive athletes, arthroscopic IFL is safe and
demonstrates favourable outcomes and high rate of symptom resolution at minimum 2
years postoperatively. The majority of patients returned to sports and maintained or
improved their competitive levels.
ePO1-338 POLYURETANE BASED NOVEL IMPLANT FOR ARTHROSCOPIC HIP LABRAL
RECONSTRUCTION
Capurro B1, Tey M2, Torres
R3, Leon A1, Marques F1
1Hospital del Mar, Barcelona, Spain; 2Hospital del Mar,
Hospital Dexeus, Barcelona, Spain; 3Clínica CEMTRO, Madrid, Spain
Introduction/objectives: Hip labrum is important for normal joint
biomechanics. Labral reconstruction is advocated when labral repair is not possible.
Auto and allograft have been used for labral reconstruction. Allogenic labral
transplantation can restore the normal shape of native labrum, but it is difficult
to obtain from tissue banks.
We applied the Orteq (R) technology of meniscal substitution of the knee to develop a
polyuretane scaffold to reconstruct hip labrum.
Methods: After improvement of the hospital ethics committee, labral
reconstruction was performed using a synthetic implantable scaffold for meniscal
reconstruction (Actifit (R), Orteq Ltd, London, UK) adapted to the hip. The scaffold
was attached to the acetabular rim with bone anchors. Follow-up was performed with
outcomes questionnaires: NAHS, HOS, iHOT33) and with Magnetic Resonance.
Results: Improvement in clinical outcomes and good reconstruction of the
labrum was seen in the magnetic resonance at 2 years follow-up.
Conclusions: Synthetic implantable scaffold is a good option for labral
reconstruction. Synthetic implantable scaffold allows intraoperative reconstruction
decision without additional morbility for the patient.
ePO1-382 1 YEAR FOLLOW-UP OF 100 PATIENTS AFTER ARTHROSCOPIC ASSISTED
MINI-OPEN APPROACH FOR THE TREATMENT OF FEMOROACETABULAR IMPINGEMENT
1Orthopädie MHH Annastift, Hannover, Germany; 2Orthopädie MHH
im Annastift, Hannover, Germany; 3Instituto Ortopedico del Mezzogiorno
d'Italia, Reggio Calabria, Italy; 4Hospital Universitario Infanta Leonor,
Madrid, Spain; 5Clinica Universitaria Dexeus, Barcelona, Spain
Introduction/objectives: Surgical treatment of femoroacetabular
impingement (FAI) is the gold standard. The primary goal of surgical treatment is to
increase joint clearance and decrease destructive forces being transmitted through
the joint.
Clinical and radiological outcome at 1 year follow-up of 100 patients after
arthroscopic assisted mini-open approach (AAMOA).
Methods: Between 09/2012 and 11/2013 100 patients were treated by means
of AAMOA for FAI treatment. The mean age was 33.5 years (range 14-65), 6 of them
were elite athletes. The patients completed the Hip Disability and Osteoarthitis
Outcome score (HOOS) and the Western Ontario and McMaster Osteoarthritis (WOMAC)
score pre-operatives and at post-operative follow up. Their specific level of
activity was specified using the University of California, Los Angeles
(UCLA)-activity score. The patients were divided in 3 groups (A,B,C) according to
the osteoarthritis grade of Tönnis.
Results: Follow-up time was 12 month. In 64 patients received labral
refixation. The HOOS-Score significantly changed from 59.6 ± 13.4 to 94.4 ± 5.4
(p<0.001) as well as the WOMAC-Score 64.3 ± 12.6 to 91.4 ± 8.4 (p<0.) in all 3
groups. The mean UCLA activity score changed significantly from 5.8 ± 1.9 to 8.2 ±
1.3 (p<0.001). The alpha-angle changed significantly from 84.3° ± 20.3 to 46.7° ±
6.2 (p<0.001).
Conclusions: Patients with higher osteoarthritis grades (Tönnis 2) show
significantly inferior results than patients with early changes of hip arthritis
(Tönnis 0 and 1). Nevertheless, the AAMOA is a reproducible procedure to treat
femoroacetabular impingement. Our 1 year results show promising and comparable
clinical and radiological results to hip arthroscopy and in conclusion can be used
as an alternative, reproducible technique for the treatment of FAI.
ePO1-320 MODIFY DUNN OSTEOTOMY IN CHRONIC SLIPPED PROXIMAL FEMORAL CAPITAL
EPIPHYSIS
de Sandes Kimura O, Freitas E, Linhares Garcia PB,
Leal DDC, Cury Fernandes MB
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: Femoroacetabular impingement associated with
healed slipped capital femoral epiphysis not only leads to an alteration in gait and
a limited range of movement of the hip, but also predisposes the hip to
chondrolabral injury and early osteoarthritis. The choice of operation has
principally been between open dislocation of the hip and osteochondroplasty,
arthroscopic osteochondroplasty and intertrochanteric repositioning osteotomy. The
purpose of this study was to evaluate the clinical and radiological efficacy of
subcapital osteotomy through a surgical dislocation/extended retinacular soft-tissue
flap approach, in the management of symptomatic FAI from a healed slipped capital
femoral epiphysis, in patients with a closed proximal femoral physis.
Methods: This was a prospective study of twenty consecutive patients who
had symptomatic FAI from a healed SCFE and were treated by subcapital osteotomy
between January 2014 and March 2016 using the surgical dislocation/retinacular flap
technique.
Results: The mean Harris Hip Score at final follow-up was 95. All
radiological measurements showed a statistically significant correction after the
osteotomy. The mean anterior slip angle improved from 40.6° to 9.3° (p<0.01). The
mean anterior slip angle improved from 32.6° to 12.6° (p<0.01). Complications
included one case of necrosis of the femoral head.
Conclusions: In conclusion, we believe that subcapital osteotomy for a
patient with a moderate to severe healed SCFE is technically demanding. However,
with the use of the described technique this operation is reasonably reproducible
and gives satisfactory clinical and radiological outcomes.
ePO1-380 TRIPLE PELVIC OSTEOTOMY IN TREATMENT OF DYSPLASTIC COXARTHROSIS IN
ADULTS
Sakalouski A1, Minakouski I1,
Darya S2
1Republican Centre for Traumatology and Orthopaedics, Minsk, Belarus;
2Belarusian Research Institute of Trauma and Orthopaedics, Minsk,
Belarus
Introduction/objectives: Hip dysplasia is a common cause of coxarthrosis
in adults (about 40%), at that, acetabulum dysplasia occurs in 80% of all the cases.
Thus, we use triple pelvic osteotomy (TPO), developed by Anatoliy Sakalouski in
1983.
Methods: We performed TPO in 67 patients (81 hips) from 1998 to 2006.
The mean age was 30.2 (18-55) years at the time of surgery, 59 patients were female
and 8 male. 27 (40.3%) operations were performed on the left joint, 26 (38.8%) – on
the right one and 14 (20.9%) patients were operated on both sides. 11 patients had
radiographic evidence of osteoarthritis stage 0, 33 – stage 1 and 37 – stage 2. The
mean duration of the follow-up was 80 (45-129) months.
Results: The mean Wiberg angle increased from 6.7° (-10-25) before the
operation to 41.5° (10-70) after it, the mean degree of coverage of the femoral head
– from 0.6 (0.3-0.83) to 0.99 (0.6.1.3), the mean Sharp angle decreased from 49.3°
(40-60) to 30° (10-43). Fifteen hips had radiographic evidence of progression of
osteoarthritis: 3-from the first to the third stage, 12 - from the second to the
third stage. Clinical evaluation of the results, made according to Tschauner et al
(1992) was: excellent - 22 (27%), good - 28 (34%), satisfactory - 20 (25%),
unsatisfactory - 11 (13%). In 61 (75%) cases patients were satisfied with the
results of treatment, in 7 (9%) cases - partially satisfied, in 13 (16%) –
unsatisfied. Six patients (7 hips) underwent total hip arthroplasty in the follow-up
period of 73 months.
Conclusions: Triple pelvic osteotomy improves hip biomechanics,
normalizes the acetabulum position, delays development of coxarthrosis in adults and
doesn't prevent further hip replacement.
ePO1-155 RECONSTRUCTIVE PROCEDURES IN TREATMENT OF COMPLEX DYSPLASTIC
COXARTHROSIS STAGE 2-3 IN YOUNG PATIENTS
Korolkov A, Bondarenko S, Mezentsev V, Akonjom
M
Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
Introduction/objectives: Our experience with pelvic osteotomies and
proximal femur procedures in surgical treatment of dysplastic coxarthrosis in young
patients.
Methods: A retrospective study of treatment of 65 patients with stages
2-3 dysplatic coxarthrosis, average age was 27,8 (16 to 40 years). 37 women and 28
men (81 hips). The following procedures were performed: a triple pelvic osteotomy-33
patients, Chiari osteotomy-11 patients, Salter osteotomy-12, Ganz pelvic
osteotomy-9. In 41 cases, acetabular osteotomy was carried out in conjunction with
proximal femoral osteotomy.
Results: The average duration of follow up was 11.5 years. The AI
increased from 25 to 45 and the coverage ratio of femoral head (CRFH) was at least
0,6. In the long-term follow up average value of these indicators amounted
respectively: AI-10, 7 CRFH - 0.97.
Ganz osteotomy was performed with an average AI of 32 and CRFH of 0.65. In long term
follow-up, average value of these indicators amounted respectively: AI - 8,5, CRFH-
0.95. Chiari osteotomy performed for hip subluxation in patients 16-20 years with
coxa magna, with a sufficient thickness of the ilium body; expressed lateral
position of the hip with symptoms of coxarthrosis 2-3 stage and deformity of the
femoral head. The AI improved from 34.7 to 11,7 and the CRFH improved from 0.58 to
0.89 in long term follow up. Good long-term results of Salter osteotomy was obtained
with AI up to 25 and CRFH not less than 0.80.
Conclusions: Long-term results of these procedures with complex
dysplastic coxarthrosis 2-3 shows their effectiveness in the treatment of pain in
patients aged 16-40 years. These procedures significantly increase the stability of
the operated joint and get up to 78.42% satisfactory results up to 11.5 years.
ePO1-344 OUTCOME MEASURES OF TOTAL HIP ARTHROPLASTY IN PATIENTS WITH
DEVELOPMENTAL DYSPLASIA OF THE HIP REFERRED TO THE SINA HOSPITAL DURING
2008-2015
Savadkoohi D, Siavashi B, Golbakhsh M, Roshandel H,
Karimnia A
Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Considering the increasing prevalence of total
hip arthroplasty (THA) and lack of information about its results in Sina Hospital,
this study was performed to evaluate the results of total hip arthroplasty, among
patients referred to Sina hospital, one of the referral centers of the Tehran
University of Medical Sciences during the years of 2008 to 2014.
Methods: This retrospective study retrieves and analyzes existing data
from patients. Patient's records were studied and the age, sex, HHS, indication for
surgery, year survival according to radiologic and clinical evaluation, and points
HH of patients were recorded and statistically evaluated.
Results: 43 patients with stable DDH were studied. The average follow-up
period was 46 months (range between quartile 30-60). The average age of patients was
46.7 (12.3) and 76.7% of patients were female. Mean of Harris hip score of patients
developed from 43.5 (95% CI: 38.5-48.5) before surgery to 83.8 (095% CI: 81.1-86.5)
independent of age, sex and Crowe classes (P<0.001). Average LLD of Participants
in the study has reduced from 3.2 (95% CI: 2.6-3.7) to 1.9 (95% CI: 1.4-2.4),
independent of age, gender and Crowe classes (p = 0.014). Based on the results of
this study, the average deviation angles bedpans dropped from 6.1 (95% CI: 4.8-9.3)
to 3.5 after THA (95% CI: 2.8-5.4), independent of age, sex and Crowe classes (p =
0.019).
Conclusions: THA can significantly enhance the quality of life and also
maintain this improvement for both sexes, in all different Crowe classifications or
any age. In addition, it can significantly enhance pelvic obliquity and decrease LLD
in patients.
ePOZ Primary THA
ePO2-364 DIRECT ANTERIOR TOTAL HIP REPLACEMENT IN SUPINE POSITION USING A
STANDARD OR TABLE: REVIEW OF COMPLICATION AND REOPERATION RATE
Introduction/objectives: Direct Anterior Approach Total Hip Replacement
(DAA-THR) has gained popularity throughout the last decade. Many hip surgeons still
have an aversion to this approach, which is rooted in early studies reporting a high
intra-operative complication rate, in particular trochanteric fractures,
perforations and wound complications. In these reports, the authors consistently
describe the use of a fracture table or positioning device. We hypothesize that
these complications are highly associated with the use these devices. We also want
to supply more data about DAA-THR in supine position using standard OR table by
reporting the first 357 DAA cases of a high volume surgeon radically switching from
approach.
Methods: We performed a multicentric retrospective data analysis of the
first 357 primary DAA-THR cases of a single surgeon from April 2011 to April 2015
(minimum follow-up of 1 year). 300 hips had a complete follow-up until the end of
the observation period. Intraoperative and early postoperative complications were
recorded.
Results: Following complications were noted: 2 dislocations (1 open
reduction), 3 persistent LFCN injuries, 1 intraoperative calcar fracture, 3 cup
loosening, 1 stem subsidence, 2 deep infections, 3 cases of heterotopic
ossification, 1 temporary femoral nerve neuropraxia, 2 cases of psoas impingement, 2
cases of unexplained pain. Revision rate was 1%. Overall reoperation rate was
3%.
Conclusions: In our opinion, the high intraoperative complication risk
does not seem to be a concern in DAA-THR in supine position on a standard OR table
and are merely due to positioning devices. It is a safe technique with a short
learning curve.
ePO2-26 NO INCREASED DISLOCATION RATE WITH MINIMAL PRECAUTIONS AFTER TOTAL HIP
ARTHROPLASTY SURGERY USING THE POSTEROLATERAL APPROACH. A PROSPECTIVE,
COMPARATIVE SAFETY STUDY
van der Weegen W, Kornuijt A, Das D
St. Anna Hospital, Geldrop, The Netherlands
Introduction/objectives: To prevent hip dislocation patients have to
adhere to precautions in the first postoperative months after total hip arthroplasty
(THA). We hypothesized that a protocol with minimal precautions after primary THA
using the posterolateral approach would not increase the short-term (<3 months)
risk of dislocation.
Methods: We prospectively monitored a cohort of unselected primary
elective THA patients managed with standard precautions (n = 109, median age 68.9;
interquartile range 61.2 to 77.3) and a cohort managed with less precautions (n =
142, median age 67.3; interquartile range 61.7 to 73.4). There were no significant
differences between the restricted group and the less restricted group regarding
predisposing risk factors. Femoral head diameter ranged from 28 mm to 36 mm and
meticulous soft tissue repair was done in all cases. Besides hospital chart review,
all patients were contacted three months postoperative to check for
dislocations.
Results: There were no dislocations in the less restricted group
compared to 1 dislocation in the restricted group (p = 0.25).
Conclusions: For experienced surgeons using the posterolateral surgical
approach and femoral head diameters ≥28 mm, it appears safe to manage THA patients
in the immediate post-operative phase with minimal precautions. Larger studies with
adequate statistical power are needed to verify this conclusion.
ePO2-131 BLOOD LOSS AND PERIOPERATIVE BLOOD TRANSFUSION: MINIMALLY INVASIVE
ANTEROLATERAL VS. TRANSGLUTEAL LATERAL APPROACH IN PRIMARY UNCEMENTED TOTAL HIP
ARTHROPLASTY
Jungel E, Aldinger P
Diakonie-Klinikum Stuttgart, Stuttgart, Germany
Introduction/objectives: Total hip arthroplasty (THA) is associated with
substantial blood loss requiring allogenic blood transfusion in 10-25%. Minimally
invasive approaches for THA offer the potential advantage of decreased perioperative
blood loss (BL). While tranexamic acid (TXA) reduces BL in THA, the effect of
closed-suction drains is controversial. Our outcome measures were BL and number
transfused in THA with minimally invasive anterolateral (MIS) vs. transgluteal
lateral (TG) approach.
Methods: A retrospective study of 429 consecutive patients who underwent
THA was performed.
MIS group: 211 patients (124 females) with mean age 67 years (35-91). No
drains were used. Pre-Operative TXA (10 mg/kg) was administered.
TG group: 218 patients (128 females) with mean age 66 years (29-94).
Closed-suction drains were removed on 2nd postoperative day. TXA
was not administered.
No intraoperative retransfusions were done in both groups. Hemoglobin (Hb) was
measured on pre-, 1st and 5th postoperative day. Exclusion
criterion was allogenic blood transfusion.
Results: The mean pre-operative Hb in MIS group was 14.2 g/dl (SD 1.3)
compared to 14.0 g/dl (SD 1.3) in TG group (p = 0.082). The mean drop in Hb on
1st and 5th postoperative day comparing to pre-operative Hb was
significantly lower in MIS group with 2.4 g/dl (SD 0.8) and 3.6 g/dl (SD 1.1)
compared to 3.4 g/dl (SD 1.1) and 4.5 g/dl (SD 1.3) in TG group (p<0.001). 5
patients (2.4%) received transfusions in MIS Group versus 51 patients (23.4%) in TG
group (p<0.001).
Conclusions: The MIS group in combination with TXA and no drains showed
a significantly decreased BL on the 1st and 5th postoperative
day and significantly less blood transfusions.
ePO2-40 THE INTRODUCTION OF NEW ANTIBIOTIC PROPHYLAXIS IN THR AND TKR AND
IMPACT ON PATIENT'S RENAL FUNCTIONS
Ara AR, Ng A, Shetty A, Akram F, Qamar F
Pinderfields General Hospital, The Mid Yorkshire Hospitals NHS Trust, Wakefield,
UK
Introduction/objectives: There has been recent change in guidelines for
antibiotic prophylaxis for total hip and knee arthroplasty. Teicoplanin is
administered in cemented and cefuroxime in un-cemented hip and knee arthroplasty.
The objectives were to assess if the antibiotic prophylaxis guidelines were met in
our institution and to identify the number of patients with acute kidney injury
after lower limb arthroplasty.
Methods: A retrospective study, questionnaire prepared, total of 104
patients participated in the study from February to June, 2015.
Results: 55 males and 49 females were involved in the study; mean of age
was 69 years (range 31-88 years). 5 patients had cemented while 33 patients had
un-cemented THR. 80% of the patients undergoing cemented THR had teicoplanin, while
only 18 out 33 patients (54%) undergoing un-cemented THR had cefuroxime. 66 patients
had cemented TKR. 63 (95.5%) had teicoplanin, 2 (3%) had cefuroxime while 1 (1.5%)
had flucloxacillin. 12 patients out of 104 (11.53%) patients showed raised urea
while 2 patients (1.92%) had raised creatinine levels. Patients with raised urea
levels, 9 (75%) had teicoplanin, 3 (25%) had cefuroxime. None of the patients with
raised U&E underwent for haemodialysis as their renal functions came to baseline
in few days. No C-difficile was recorded in the study
Conclusions: Teicoplanin should be administered as prophylactic
antibiotic for cemented arthroplasty while cefuroxime for uncemented arthroplasty.
Renal functions should be closely monitored. Both antibiotics have little impact on
patient's renal functions and no AKI were seen during this period.
ePO2-125 SHORT-TERM OUTCOMES OF ONE-STAGE BILATERAL TOTAL HIP ARTHROPLASTY IN
YOUNG PATIENTS UNDER 30
Taheriazam A1, Safdari F2,
Saeidinia A3
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Shahid Beheshti University of Medical Sciences, Bone,
Joint and Related Tissue Research Centre, Tehran, Islamic Republic of Iran;
3Guilan University of Medical Sciences, Rasht, Islamic Republic of
Iran
Introduction/objectives: Total hip arthroplasty is one solution for
restoring function and activity in young patients with juvenile rheumatoid
arthritis. One-stage bilateral total hip arthroplasty (BTHA) offers many advantages
which are important to younger patients and diminished costs and time. There are
some concerns about the safety of the procedure.
Methods: Between April 2010 and September 2015, 180 patients underwent
one-stage BTHAs through direct lateral. Postel-Merle d'Aubigné (PMA) score, Oxford
Hip Score (OHS), Visual Analogue Scale (VAS) Score, and Modified Harris Hip Score
(MHHS) were completed for all patients pre- and postoperatively to evaluate
functional outcomes. All complications were followed closely for a period of 4.67 ±
0.54 years.
Results: The mean operation time and the average length of hospital stay
were 156 ± 23 minutes and 5.20 ± 2.44 days, respectively. We reported 3 patients
developed unilateral, temporary peroneal nerve palsy (1.66%), 3 intra-operative
fracture (1.66%), two patients (1.11%) with deep vein thrombosis and four patients
(2.22%) with superficial wound infection. The functional scores in every diagnosis
of patients, improvement was better in avascular necrosis (AVN) than, rheumatoid
arthritis (RA), juvenile rheumatoid arthritis (JRA), slipped capital femoral
epiphysis (SCFE) and developmental dysplasia of the hip (DDH), respectively. There
were significant differences between diagnosis and every functional score separately
(p<0.05).
Conclusions: Our results showed that one stage bilateral THA provides
improved hip function and stable implant fixation at short- to midterm follow up and
we suggested one-stage cementless THA in bilateral advanced arthritis in patients
younger than 30 years.
ePO2-7 ONE-STAGE BILATERAL TOTAL HIP ARTHROPLASTY THROUGH A MINIMALLY INVASIVE
ANTERIOR APPROACH (AMIS): FUNCTIONAL OUTCOMES AND COMPLICATIONS IN 45 PATIENTS
WITH 2-YEAR FOLLOW-UP
Petridis G, Nolde M
Orthopraxx, Zentrum für Orthopädie, Munich, Germany
Introduction/objectives: One-stage bilateral total hip arthroplasty
(THA) has many advantages such as a single hospital stay, a shorter rehabilitation
time and decreased management costs per patient. The use of this strategy is limited
cause a possible increase in the perioperative complication rate. In this study our
objectives were to evaluate functional outcomes and complications in patients
managed with one-stage bilateral total hip arthroplasty performed by a minimally
invasive anterior approach.
Methods: Two German surgical centres participated in a retrospective
study of patients managed with one-stage bilateral minimally invasive THA performed
by one surgeon. The 45 included patients (31 female, 14 male) had a mean age 56
years (35-77) and a follow-up of 24 months.
Results: Mean hospital stay length were 9.2 days (6-18), mean operative
time was 165 minutes (92-185), mean blood loss intraoperatively was 548.9 ml, and
mean haemoglobin levels were 14.3 g/dl pre-operatively and 11.1 g/dl
postoperatively. No perioperative complications or deaths were recorded. The Harris
hip score (HHS) improved from 40.87 ± 16.45 pre-operatively to 98.89 ± 1.13 at last
follow-up. The High Activity Arthroplasty Score (HAAS) improved from 7.47 ± 2.90
pre-operatively to 14.52 ± 1.36 after 24 months postoperatively. The general quality
of life questionnaire (FLZ) improved from 59.62 ± 8.56 to 71.11 ± 6.04 and the
health quality of life questionnaire (FLZ) improved from 60.00 ± 7.05 to 72.86 ±
5.29.
Conclusions: The results of this multicentre retrospective study
indicate that one-stage bilateral THA through a minimally invasive anterior approach
is a valid alternative to two-stage bilateral THA in American society of
anaesthesiologists score (ASA) 1, 2 and 3 patients with a pre-operative haemoglobin
level of about 14 g/dL. No complications were recorded.
ePO2-398 IS BILATERAL TOTAL HIP ARTHROPLASTY SAFE? AN INSTITUTIONAL ANALYSIS
OF 3901 PATIENTS
Poultsides L, Triantafyllopoulos G, Memtsoudis S, Do
H, Alexiades M, Sculco T
Hospital for Special Surgery, New York, NY, USA
Introduction/objectives: Bilateral hip disease is a relatively common
entity. These patients may be eligible for same-day (SD) or staged bilateral total
hip arthroplasty (BTHA). Our objectives were to: 1) compare rates of in-hospital
complications and blood transfusion rates between patients undergoing same-day and
staged BTHA; and 2) determine risk factors for major complications in these
patients.
Methods: We retrospectively reviewed institutional data for 3901
patients with bilateral hip arthritis from 1999 to 2014; 1949 underwent SDBTHA
(Group A) and 1952 underwent staged BTHA (Group B). Patient demographics and Deyo
comorbidity indices were recorded. Complications were categorized into local and
systemic (minor and major). A univariate analysis was performed to identify
differences in complications and blood transfusion rates between the two groups. A
multivariable logistic regression model was built to determine risk factors for
major complications.
Results: Patients of Group A were significantly younger (56.3 ± 12.0 vs
63.4 ± 12.6 years; p<0.001). Mean Deyo index was significantly lower for Group A
(p<0.001). Group A had significantly lower overall rates of minor (10.06% vs
13.88%; p<0.001) and major complications (4.41% vs 5.99%; p = 0.026). Group A had
significantly higher total (1.5 ± 1.1 vs 1.0 ± 1.2 units; p<0.001) and allogeneic
blood transfusion rates (0.4 ± 0.7 vs 0.3 ± 0.8 units; p<0.001). Older age, Deyo
index equal to or more than 2 and earlier year of admission were associated with
increased odds for major complications.
Conclusions: Same-day bilateral THA is a reasonable and safe option for
younger and healthier patients with bilateral hip disease.
ePO2-16 PREDICTING LONG-TERM OUTCOME IN CEMENTED TOTAL HIP ARTHROPLASTY:
DETERMINING PROGNOSIS BY EARLY RADIOLOGICAL FINDINGS
Hirose S, Morishima T, Watanabe K, Inamori S, Deie
M
Aichi Medical University, Nagakute, Japan
Introduction/objectives: Cementing techniques in total hip arthroplasty
(THA) have improved. The aim of our study was to analyse the relationship between
early radiological findings and later component loosening in cemented THA by using
second-generation techniques and to predict the long-term effects by using
third-generation techniques.
Methods: We reviewed the radiologic results of 91 Charnley THA performed
for osteoarthritis. Second-generation techniques involved making multiple anchor
holes on the acetabular side, and plug and retrograde filling with a cement gun on
the femoral side in 57 hips. The average follow-up duration was 15 years (range
10-21 years). Third-generation techniques involved additional vacuum mixing and
cement pressurization in 34 hips. The average follow-up duration was 8 years (range
5-11 years).
Results: The survival rate at 20 years when using second-generation
techniques was 89% for the socket and 94% for the stem, with aseptic loosening as
the end point. The respective survival rate at 10 years when using third-generation
techniques was 97% and 100%. According to our radiographic evaluation system (using
clear zone score) at 5 years, the clear zone in the stable socket had a lower score
than in the loosened socket when using second-generation techniques. Similarly, the
clear zone on the acetabular side had a lower score when using third-generation
techniques compared with second-generation techniques.
Conclusions: Second- and third-generation cementing techniques both
showed excellent survivorship. The clear zone score at 5 years suggest that early
radiological findings relate to later socket loosening, and the long-term effects of
the third-generation techniques will likely surpass those of the second-generation
techniques on acetabular side.
ePO2-302 THE FIRST 6 WEEKS OF RECOVERY AFTER PRIMARY TOTAL HIP ARTHROPLASTY
WITH FAST-TRACK
Klapwijk L, Mathijssen N, van Egmond J, Vehmeijer
S
Reinier de Graaf Hospital, Delft, The Netherlands
Introduction/objectives: Fast-track protocols have been introduced
worldwide to improve the recovery after total hip arthroplasty (THA). These
protocols reduced the length of hospital stay (LOS). Furthermore, THA in an
outpatient setting is feasible. Due to short LOS, less is known regarding the first
weeks of recovery. The present study will determine patients' experiences of the
first 6 weeks after hospital discharge subsequent inpatient or outpatient THA
surgery with fast-track.
Methods: In a prospective cohort study, 100 consecutive patients with
THA surgery in a fast-track setting, between February 2015 and October 2015 were
included and received a diary for 6 weeks. This diary contained various
international validated questionnaires including HOOS-PS, OHS, EQ-5D, SF-12 and
ICOAP. In addition, general questions regarding pain, the wound, physiotherapy, and
thrombosis prophylaxis injections were posted.
Results: 94 patients completed the diary, of which 42 patients were
operated in an outpatient setting. 91 patients were satisfied with short LOS. Pain
and concomitant use of pain medication gradually decreased during the 6 weeks.
Function and quality of life gradually improved. After 6 weeks, 91% of all patients
indicated improvement in functioning compared to pre-operative function.
Conclusions: Fast-track protocols are generally accepted by most
patients. During the first 6 weeks pain scores decreased and function scores
increased. 97% of the patients were satisfied with the short LOS. It seems inpatient
and outpatient patients are different, based on variations in pain and function
scores and satisfaction rate.
ePO2-47 A COMPARATIVE STUDY BETWEEN FAST TRACK TOTAL HIP ARTHROPLASTY AND
STANDARD CARE
Savadkoohi D, Siavashi B, Pendar E, Aalirezaei
A
Tehran University of Medical Sciences, Sina Hospital, Tehran, Islamic Republic of
Iran
Introduction/objectives: Current trend in total hip arthroplasty is fast
track total hip arthroplasty with shorter hospital stay. This study compares fast
track THA with standard care.
Methods: It is a prospective study. THA cases (primary, unilateral) were
studied. There were 2 groups (standard care and fast track) and two sub groups
(40-60 years old and 60-80 years old). They followed for 1 year and hip scores (HHS,
OHS, WOMAC) and other complications (dislocation, infection, DVT, IHD, …) were
recorded.
Results: There were 46 patients in each group. Age, sex and underlying
cause of hip destruction were matched. Average hospital stay in each group was 7
days and 2 days in standard care and fast track group respectively. There were lower
scores in 2 weeks follow up of fast track but reach to standard care scores at one
year follow up. Total costs (hospital stay, operation charge and prosthesis fees)
are significantly lower in fast track group because of less duration of hospital
stay and related charges.
Conclusions: It seems that fast track THA has similar results with
standard care with much lower price.
ePO2-388 DOES HANDGRIP STRENGTH AFFECT KINESIOPHOBIA IN PATIENTS WITH TOTAL
HIP ARTHROPLASTY
Çekmece S1, ünver B1, Karatosun
V2, Günal IH2
1Eylul University, School of Physical Therapy and Rehabilitation, Izmir,
Turkey; 2Eylul University, Department of Orthopaedics, Faculty of
Medicine, Izmir, Turkey
Introduction/objectives: Low muscle strength is associated with
mobility, presumably as a result of low muscle mass and physical inactivity. Grip
strength has long been thought of as a possible predictor of overall body strength.
The influence of kinesiophobia on disability level in patients with osteoarthritis
is known, but hand grip strengths influence on Kinesiophobia in patients with total
hip arthroplasty (THA) is still unknown.
The aim of this study was to investigate relationship between handgrip strength and
kinesiophobia in patients with THA.
Methods: Thirty-five patients with THA were assessed in Dokuz Eylül
University Hospital in Turkey. Hand grip strength was assessed pre-operatively and
Tampa Kinesiophobia Scale (TKS) used to measure Kinesiophobia level after operation.
We analysed the results with SPSS 22.0 bivariate correlation and coefficient.
Results: The mean age for this study was 63.5. There was a significant
correlation between hand grip strength and TKS (r-345, p<0.05).
Conclusions: Patients with lower muscle strength have more fear of
movement and this may affect the rehabilitation success. So the rehabilitation
period is much longer in patients with poor muscle strength. Pre-Operative
rehabilitation may be necessary for patients with low muscle strength.
ePO2-404 TEST-RETEST RELIABILITY OF THE TIMED SUPINE-TO-STAND TEST IN PATIENTS
WITH TOTAL HIP REPLACEMENT
Çekmece S1, Yüksel E2, ünver
B3, Karatosun V4
1Eylul University, School of Physical Therapy and Rehabilitation, Izmir,
Turkey; 2Eylul University, School of Physical Therapy and Rehabilitation,
Izmir, Turkey; 3Eylul University, School of Physical Therapy and
Rehabilitation, Izmir, Turkey; 4Eylul University, Department of
Orthopaedics, Faculty of Medicine, Izmir, Turkey
Introduction/objectives: Fall risk is influenced by various motor
factors, as evidenced by reports. To predict the risk of falling, complex motor
function should be evaluated. The Timed Supine-to-Stand Test (TSST) was used as
domain of agility, because the TSST involves three factors for agility; the time for
starting of the motion, the time for changing of the motion, and the twitch
contraction speed of the muscle. The TSST is also used as a test of agility to
identify postoperative improvement in patients with Total Hip Replacement (THR).
However, there is lack of evidence about the reliability of the TSST in patients
with THR.
The purpose of this study was to investigate test-retest reliability of the TSST in
patients with THR.
Methods: Twenty-one patients with THR (10 females, 11 male) performed
twice trials for TSST on the same. Between the first and second trials, patients
waited for an hour on sitting position in order to prevent fatigue. To assess
reliability, intra- class coefficient [ICC (2,1)], standard error of measurement
(SEM) smallest real difference at the 95% confidence level (SRD95) were
calculated.
Results: There was no significant difference between the trials
(p>0.05). ICC, SEM and SRD95 for ten step agility were 0.97, 0.12 and 0.33
respectively.
Conclusions: Reliability of TSST was excellent for patients with THR.
This test is inexpensive, simple, less time consuming and sensitive method to
measure the agility, activity daily living in patients with THR in the clinical
settings. Clinicians and researchers can use this performance test as complementary
outcome measure for functional evaluation of THR patients. Moreover, this test can
be used to quantify even small changes in functional performance after
rehabilitation programs for patients with THR.
ePO2-371 DOES PRE-OPERATIVE BODY WEIGHT AFFECT EARLY POSTOPERATIVE FUNCTIONAL
ACTIVITIES IN PATIENTS WITH TOTAL HIP ARTHROPLASTY?
Unver B1, Karatosun V2
1School of Physiotherapy, Dokuz Eylül University, Izmir, Turkey;
2Department of Orthopaedics, School of Medicine, Izmir, Turkey
Introduction/objectives: Survey data indicated that sit-to-stand,
supine-to-sit, ambulation, stair climbing and ambulation velocity were the criteria
used for discharging patients with total hip arthroplasty from physical therapy. The
present study was planned to determine the effects of obesity on functional
activities which are among the important discharge criteria for patients with total
hip arthroplasty.
Methods: The study included 45 patients who underwent surgery because of
coxarthrosis. The patients were assigned to two groups based on their pre-operative
body mass indexes (BMI): obese (BMI>30 kg/m2) and non-obese (BMI<30
kg/m2). Before the surgery, on postoperative 2nd and
6th days and at discharge, obese and non-obese patients' functional
movements (sit-to-stand, supine-to-sit, ambulation, stair climbing and ambulation
velocity) were assessed with the Iowa Level of Assistance Scale and their walking
speed was assessed with the Iowa Ambulation Velocity Scale.
Results: No difference was determined between the obese and non-obese
patients on the postoperative 2nd and 6th days and at
discharge in terms of pre-operative functional movements and walking speeds
(p>0.05). The length of hospital stay did not lead to any differences between the
obese and non-obese patients in terms of functional movements and walking
speeds.
Conclusions: To obtain further results, studies which comprise larger
samples including morbidly obese patients and in which other factors likely to
affect early functional are analysed should be conducted, which may help
physiotherapists to determine effective treatment strategies at the planning stage
of their treatment programs.
ePO2-33 THE ROLE OF EDMONTON FRAILTY SCORE AND ASA GRADING IN ASSESSING THE
MORBIDITY AND MORTALITY OF FRACTURE NECK OF FEMURS IN ELDERLY PATIENTS
Rajeev A, Anto J
Queen Elizabeth Hospital, Gatesheah Health NHS Trust, Gateshead, UK
Introduction/objectives: Frailty is a complex syndrome which affects the
energy, physical ability, cognition and general health. Hip fractures are associated
with causes and consequences of frailty such as osteoporosis, frequent falls, low
body mass index, multiple medications and cognitive impairment. The aim of our study
is to assess the value of ASA grade and Edmonton frailty score in the outcome of
treatment of fracture neck of femurs in elderly patients.
Methods: 480 patients admitted with fracture neck of femur were included
in the study. The mean age was 79.23 years. Three hundred patients had ASA grade 3,
140 patients had ASA grade 2 and 40 patients had ASA grade 1. The frailty index was
calculated using Edmonton scoring index. Two hundred and twenty two patients had
mild score, 70 patients had moderate and 190 patients had severe frailty score. All
patients were followed up 4 weeks and one year after the surgery.
Results: One hundred and fifty patients with ASA grade 3 had severe
frailty score. 130 patients with ASA grade 3 and 40 patients with high frailty score
had peri-operative morbidity. The 82 patients (43%) who died within one year had ASA
grade 3 and high frailty scores. 190 patients (73%) with moderate to high frailty
scores were able to mobilise outdoors. The average stay in the hospital was 18 days
for patients with high frailty scores. Fifty patients with high frailty index had
complications such as wound infection, pneumonia and one patient had deep vein
thrombosis.
Conclusions: The mortality rate is 58% in patients with high frailty
index. In conclusion patients with high frailty index has got higher incidence of
mortality and morbidity following fracture neck of femur.
ePO2-132 CEMENTLESS THA FOLLOWING CONSEQUENCES OF PROXIMAL FEMUR
FRACTURES
Bondarenko S, Filipenko V, Mandus A, Mezentsev
V
Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
Introduction/objectives: THA following consequences of proximal femur
fractures are less satisfactory with high complication rates compared with primary
THA due to osteoarthritis.
Methods: 63 patients (63 hips) undergoing cementless THA with sequalae
of proximal femur fractures. 37 non-union of femoral neck fracture, 5 non-union of
intertrochanteric fracture, 1 non-union of subtrochanteric fracture, 5 cases of
unacceptable implant position, 8 posttraumatic osteoarthritis, 5 posttraumatic
osteonecrosis of the hip, 2 defects of proximal femur due to infected
osteosynthesis. Average age was 62 years (36-77), 42 males and 21 females. Enhancing
of osteoporotic acetabular walls using autografts, allografts and ceramics was done
in 20 cases to achieve press-fit effect and primary stability. Metaphyseal type
stems were used in 10 cases, distally fixed type stems in 35 cases and monobloc
conically tapered revision stems in 8 cases. The reconstruction of acetabular
defects was performed with allografts in 4 cases and proximal femoral defects with
auto/allografts in 25 cases. Circlage wires and cables were used to prevent
periprosthetic fractures in 8 cases.
Results: The medium duration of follow up was 4.5 years (range 2 to 7
years). The average pre-and postoperative HHS were 31.2 and 76.4. There were 3
dislocations, 2 incidences of intraoperative femoral fractures, 2 avulsions of the
greater trochanter postoperatively. There were 2 cases of surgical site infection.
There were no femoral or acetabular component failures or revisions.
Conclusions: The final outcome of cementless THA following consequences
of proximal femoral fractures shows good results using differential approach in
restoring anatomy. The achievement of primary fixation and stability of the implants
improved the overall outcomes.
ePO2-177 MIDTERM OUTCOME OF MODIFIED WAGNER CONE MODULAR FEMORAL COMPONENT IN
COMPLEX PRIMARY TOTAL HIP ARTHROPLASTY USING ANTEROLATERAL APPROACH
Steno B
II. University Department of Orthopaedic and Trauma Surgery, University Hospital
Bratislava, Bratislava, Slovakia
Introduction/objectives: Reconstruction of the centre of rotation,
recreation of biomechanical conditions, during total hip arthroplasty is mandatory.
It may be challenging to achieve this in distorted proximal femoral anatomy
particularly in postdysplastic osteoarthritis, with or without previous surgery.
Modularity of the stem helps to achieve this. There have been issues on safety of
implant modularity. Objective of the study was to analyse the results and safety of
implanted Modulus femoral stem. It is a short, tapered stem with radial ribs.
Methods: A prospective study 2008-2015 of 74 Modulus modular femoral
stems implanted was conducted. The indication for surgery was complex
osteoarthritis, mostly postdysplastic (57 cases). Performance of the prosthesis,
possible signs of modular system disintegration, marks corrosion, subsidence of
modular femoral stems were closely radiologically evaluated.
Results: There have been 14 men (average age 55) and 60 women (average
age 57). The mean follow-up was 35 months (14-70 months). None of the patients was
lost in this study. No signs of stem subsidence, component disunion were noted. One
revision due to intraoperative femoral fracture due to severe osteoporosis occurred.
Revision done with a distally fixed modular stem combined with cable wires lead to
full anatomic fracture healing. Radiological studies did not shown marks of possible
corrosion. No revision for aseptic, septic, prosthesis dislocation or any other
reason was performed.
Conclusions: Survival and outcome of Modulus - modular femoral stem used
in complex primary cases is comparable to results of non-modular components used in
primary osteoarthritis. It is a safe implant and enables the surgeon
intraoperatively balance the soft tissues and correct limb length discrepancy.
ePO2-11 EXCELLENT MID-TERM RESULTS OF A NEW POLISHED TAPERED MODULAR CEMENTED
STEM
Somers J, Vanbiervliet J
Jan Yperman Hospital, Ypres, Belgium
Introduction/objectives: A study was set up to evaluate a new cemented
tapered Cobalt-Chrome (Co-Cr) stem with a Titanium (Ti) modular neck for which there
are no clinical data up to date.
Methods: This prospective cohort study reports the medium term clinical
and radiographic results of 115 hips treated with a hybrid Total Hip Replacement
(THR) with a new cemented tapered Cobalt-Chrome (Co-Cr) stem with a Titanium (Ti)
modular neck. Two patients were lost to follow-up.
Results: Survivorship of the implant (stem and modular neck) at a mean
of 5,5 years (min 4 - max 7) was 100% with the endpoint revision for any reason. No
implant was at risk for revision or showed signs of loosening. Clinical results were
excellent showing significant improvement in all clinical scores. The mean HHS
improved from 31 (range 2-68) to 90 (range 44-100) (p<0.0001). The mean
WOMAC-score improved from 30 (range 3-58) to 91 (range 46-100) (p<0.0001). The
mean UCLA Activity Score improved from 3 (range 1-6) to 6 (range 3-8) (p<0.0001).
The mean Oxford score was 44 (range 21-48) at follow-up. No patient reported
clicking or squeaking.
No implant showed development of radiolucent lines, either at the stem-cement or
cement-bone interface. No hip showed osteolysis or calcar resorption. The mean
femoral subsidence of the stem within the cement mantel was 0.31 mm (range min 0 -
max 0.6 mm) after 5.5 years, showing a similar migration and loading pattern as the
Exeter stem.
Conclusions: Excellent clinical and radiographic results were obtained
at 5.5 year follow-up. With the use of this modular stem, 99% of patients showed no
measurable leg length difference after THR, and leg length could be restored within
a 5 mm limit in 99% of hips.
ePO3 Trauma
ePO3-171 HIP-SPINE SYNDROME IN THE ETIOPATHOGENESIS OF AVASCULAR NECROSIS OF
THE FEMORAL HEAD
Shilnikov V. Tikhilov R, Denisov A, Shubnyakov
I
Vreden Russian Institute of Traumatology and Orthopaedics, S.Petersburg, Russian
Federation
Introduction/objectives: In the literature, the combination of pathology
of the lumbosacral spine and the hip is called a hip - spine syndrome. One of the
manifestations of such an alliance may be avascular necrosis of the femoral head
(AVN) and the transition of the lumbar vertebra. The aim of the study was to analyze
the frequency of occurrence of a combination of idiopathic AVN and other
degenerative diseases of the hip joint with the transitional vertebra of the
lumbosacral spine.
Methods: At Vreden institute during 2011-2014 were analyzed by X-ray in
patients with degenerative-dystrophic diseases of the hip joint in the number of 617
people. Of these, 184 (30%) were diagnosed with idiopathic avascular necrosis - I
group in 6% (40 patients) AVN diagnosed in conjunction with the secondary
osteoarthritis - II group and in 64% (393 patients), respectively - diagnosed
idiopathic osteoarthritis - III group.
Results: A total of 617 studies in 230 (37%) of patients diagnosed
transitional vertebra of the lumbosacral spine. Patients with an AVN incidence of
vertebral transition were 63% (116 of 184 patients). The incidence of transitional
vertebrae in group II was 20% (8 patients). In patients with idiopathic
osteoarthritis incidence transition vertebra was 10% (38 of 393 patients).
Therefore, the transitional vertebra as the most demonstrative X-ray pattern, which
is one of the links of the hip - spine syndrome can affect the etiopathogenesis AVN
and other degenerative diseases of the hip joint.
Conclusions: The results obtained in the form of the analysis provide a
basis for further research, the data used to develop the methods of prevention and
treatment interventions in the early stages of a degenerative disease of the hip –
dystrophic.
ePO3-67 PATHOLOGY ABOUT ABSENCE OF JOINT SPACE NARROWING COXARTHRITIS OF
DDH
Matsubara M, Kimura A, Kase M, Ogawa H, Yamada J,
Okuda N, Sato A
Department of Orthopaedic Surgery, Nissan Tamagawa Hospital, Tokyo, Japan
Introduction/objectives: One of the causes of inguinal pain without
abnormal radiographic change about hip joint of developmental dysplasia of the hip
was assessed by computed tomography (CT).
Methods: Although the clear cause is not found in particular, a patient
is the case which developed strong coxalgia and in other hospitals, 30 patients of
33 hip joint that has been diagnosed with normal or very early hip osteoarthritis in
the simple X-ray image. 32 female hips and 1 male hip, the average age was 63 years
old were involved in this study and the period from the onset to our department
visits were an average 12 months. We checked the cause of the sharp pain by taking
patient's plain radiography and computed tomography (CT) of the hip joint.
Results: All the cases showed no narrowing or slightly narrowing of the
joint space on the plain X-ray image. Only in the CT axial image, they showed
disappearing supero-anterior part of the hip joint cartilage. In a three-dimensional
CT reconstruction sagittal image, the cartilage of cranioanterior part of hip joint
disappeared widely in all cases, and was diagnosed advanced coxarthritis.
Conclusions: About 90% of osteoarthritis of the hip of the Japanese is a
secondary hip osteoarthritis associated with acetabular dysplasia. The diagnosis is
usually made in a plain radiogram. However, when the loss of only antero- superior
or anterior articular cartilage of the hip joint is occurring as in this case, it
may initially without narrowing apparent joint space on the plain X-ray image. CT
examination rather than plain radiogram for such cases was very useful.
ePO3-54 DISLOCATION FRACTURE OF THE HIP CAUSED BY A DEPRESSED FRACTURE OF THE
FEMORAL HEAD CORRESPONDING TO A HILL-SACHS LESION OF THE SHOULDER: A CASE
REPORT
1Akita Hip Research group, Akita, Japan; 2Akita Hip Research
group, Department of Orthopaedic Surgery, Akita University, Akita, Japan
Introduction: The Pipkin classification is a representative
classification of femoral head fractures that is useful for determining the
treatment strategy. A case of hip dislocation fracture that was easily re-dislocated
because there was a femoral head depressed fracture that did not fulfil the
classification is reported.
Case presentation: A 59-year-old man fell from a roof and his left hip
joint was dislocated posteriorly. He was admitted to a nearby hospital, and he was
referred to our hospital more than 24 hours after injury. Computed tomography
suggested a bone chip, 24 mm × 10 mm × 3 mm, from the posterior wall of the
acetabular roof and a depressed femoral head that cut into the posterior margin of
the acetabular roof. Immediate manual repositioning was performed under general
anaesthesia on the same day. He left our hospital to go home on day 26 after
repositioning, but his left hip joint was dislocated again when he went down the
stairs. He was re-hospitalized 4 days after discharge. Closed repositioning was
again performed, but his hip joint could be dislocated easily. It was thought that
this patient's redislocation occurred due to a femoral head depressed fracture
involving the same mechanism as the Hill-Sachs injury seen with dislocation of the
shoulder. The Remplissage method for the Hill-Sachs injury is difficult for the
femoral head. Therefore, total hip replacement was performed, and the patient's
postoperative course was good.
Conclusions: A rare case of hip dislocation fracture was presented. Even
though the bone chip of the acetabulum posterior wall fracture is small in a hip
dislocation fracture, we should be careful about redislocation due to a depressed
femoral head fracture.
ePO3-156 SURGICAL TREATMENT OF POSTERIOR WALL FRACTURE COMBINED WITH FEMORAL
HEAD FRACTURE - EFFECTIVENESS OF SURGICAL DISLOCATION FOR FEMORAL HEAD
FRACTURE
Nakamura Y, Chosa E, Sakamoto T, Ikejiri H, Hiyoshi
M, Kawano K
University of Miyazaki, Miyazaki-shi, Japan
Introduction/objectives: The purpose of surgical treatment of posterior
wall fractures is to restore the joint congruency of acetabulum and femoral head by
anatomic reduction of the articular surface. Fractures of the posterior wall are the
most common, however posterior wall fracture combined with femoral head is very
rare. The keys to surgical success include exact reduction of the posterior
fragments and the femoral head itself, using Kocher-Langenbech approach combined
with surgical dislocation (Combined technique).
Methods: Between 2010 and 2012, 11 cases were approached through K-L
approach with or without surgical dislocation. There were 8 males and 3 females. The
averaged age was 52.2 years. Posterior fracture patterns were; Type I/II/III 2/7/2
cases, femoral head fracture patterns were; Ciron I-B/II-B/III-B 2/4/5 cases.
Surgical dislocation was needed for 9 cases, other were resected the femoral bone
fragments. Clinical and radiographic results, complication were evaluated.
Results: Clinical results were; excellent: 5, good: 3, poor 3 cases.
Poor cases (all of the cases were femoral fragments resected) needed total hip
arthroplasty.
Conclusions: Removal of femoral head fragments leads to incongruency of
the joint, resulting in the poor results. Proactively using surgical dislocation for
femoral head fractures, and should aim to improve the joint congruency.
ePO3-351 RISK FACTORS FOR MEDICAL AND ORTHOPAEDIC COMPLICATIONS AFTER A HIP
FRACTURE: SURGICAL DELAY AS A RISK FACTOR FOR WOUND INFECTION
Cordero-Ampuero J, Iborra S, Maldonado A
Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Madrid, Spain
Introduction/objectives: Analysis of significant risk factors for
mortality and complications.
Methods: Observational, prospective. Consecutive (Dec 2012-Dec 2014) 697
hip fracture patients, 84.7 ± 8.9 years, 520 female (74.6%). Treatment for 308
(44.2%) intracapsular: conservative (19), cannulated screws (58), arthroplasty (228
bipolar, 3 total); for 389 extracapsular (55.8%): trochanteric nail (375), hip-screw
(14). Clinical and radiographic control after 1, 3, 6, 12 months. Bivariate analysis
(Pearson, Mann-Whitney, Wilcoxon), Odds Ratio.
Results: Surgical delay: 2.11 ± 2.2 days, 1.7 ± 1.9 medically stable
patients, main reason anticoagulant/antiplatelet. Immediate weight-bearing: 71.9%.
Time in-hospital: 11.6 ± 7.6 days (2-99). Return to previous habitat: 63%. Lost-to-
follow-up: 4.1% after 1 month, 8% after 6. Unable to walk after 1 year: 6.2% of
previous walkers. Mortality: 4.3% in-hospital, 13.8% after 1 year; older age only
significant risk factor (p = 0.004, OR 1.9 (1.2-3). Wound infection: 2.3%, surgical
delay over 24 hours significant (p = 0.023, OR 3.48 (1.1-10.8). Fixation failure:
7.9% cannulated screws, 1.9% trochanteric nails (1.1% cut-out, 0.8% nail fracture).
Arthroplasty complications: 2.7% dislocation, 1.3% periprosthetic fracture. Medical
complications: Pyelonefritis 6.7%, pneumonia 6.3%, cardiac failure 2.2%; significant
risk factors: previous comorbidity for pneumonia (p = 0.007, OR 2.7 (1.3-5.7) and
cardiac failure (p = 0.007, OR 9.7 (1.3-74.9), older age for pneumonia (p = 0.006,
OR 2.2 (1.3-5.3).
Conclusions: Surgical delay over 24 hours is a significant risk factor
for wound infection (not previously described), older age for mortality and
pneumonia, and previous comorbidity for cardiac failure and pneumonia.
ePO3-345 ANALYSIS OF THE TREATMENT FAILURES FOR INTERTROCHANTERIC FRACTURES
WITH DYNAMIC HIP SCREW (DHS)
Savadkoohi D, Siavashi B, Golbakhsh M, Karimnia A,
Roshandel H
Tehran University of Medical Sciences, Sina Hospital, Tehran, Islamic Republic of
Iran
Introduction/objectives: Intertrochanteric fracture treatment is one of
the orthopaedic problems in the elderly. Especially in unstable fractures and
patients with osteoporosis the outcome of treatment is not satisfactory. Several
factors affect treatment outcomes and in this study, the causes of treatment failure
using DHS was evaluated.
Methods: Of the 648 patients with intertrochanteric fracture admitted to
Sina hospital during 2011-2015 years and were treated with DHS, causes of treatment
failure in 28 patients who experienced treatment failure with DHS was
investigated.
Results: 75% of patient who had failed treatment with DHS, were women,
25% of them were male.
The average age of patients with treatment failure, was 76.73 ± 13.21 years and in
patients with no treatment failure was 70.5 ± 12.7 years. There was significant
difference between the mean age of the patients who had failed treatment with DHS
and patients that their treatment was to be a success. No significant differences
between the two groups of patients with and without treatment failure in
osteoporosis. Patients with treatment failure had the mean BMI higher.
No significant differences between patients with and without treatment failure in
terms of fracture type. The cause of 71% of cases of treatment failure was nail
cut-out. TAD in 70% of these cases was higher than 25 mm and in 71.42% of these
cases, nail position was superioranterior.
Conclusions: For intertrochanteric fracture, to interfix with DHS is an
effective method. Older age, high BMI and TAD higher than standard 25 mm included
the risk factors for treatment failure with DHS. The cut of point of TAD was
calculated at 15.5 mm.
ePO3-272 USE OF LONG CEPHALOMEDULLARY NAIL IN OSTEOPOROTIC TROCHANTERIC
FRACTURES WITH WIDE MEDULLARY CANAL
Choo SK, Oh HK, Koh KH, Oh SH, Chang YS
Department of Orthopaedic Surgery, Inje University, Koyang City, Republic of Korea
(South Korea)
Introduction/objectives: Although mechanical stability of long and short
nail has proven to be equivocal in many studies, our hypothesis is that long nail
can prevent complications in very osteoporotic bones. Use of long nails (LN) in wide
medullary canal are compared to short nails (SN) in osteoporotic bones.
Methods: From 2013.1 to 2015.5 there were 277 intertrochanteric
fractures of 65 years or older and there chart and x-ray was reviewed
retrospectively. During the period, fracture with femoral canal at the isthmus which
was more than 17 mm were used long nail. Twenty seven cephlomedullary LN were used
in medullary canal wider than 17 mm at the isthmus (Group A). The control group are
the 79 SN used in canals wider than 15 mm at the isthmus (Group B). The
pre-operative BMD and general status (ASA), operating time (min), blood loss (ml),
and complications were compared between the two groups (Group A and B). Minimum f/u
was 4 months.
Results: The medullary canal diameter of Gr A was from 17 mm to 22 mm
and average was 18.5 mm. In Gr B, 15 mm to 22 mm and average 16.5 mm. The ASA of the
two groups were Gr A 2.19, Gr B 2.24. The BMD of the two groups were Gr A −3.10 Gr B
−2.79. The general condition was similar but the condition of the bone was much
poorer in Gr A. Blood loss was 124cc in Gr A, 102.4cc in Gr B. The operating time
was average 65 minutes in Gr A, 45.5 minutes in Gr B. There were no metal failure in
Gr A but one cutting out in Gr B and two nearly cutting out in Gr B.
Conclusions: These two groups are difficult to compare, bone quality was
poorer in long nail group, even though it requires slightly more time and blood
loss, but it can achieve compatibly good results in these very osteoporotic and sick
patients compared to using conventional short nails.
ePO3-265 CEMENTLESS BIPOLAR HEMIARTHROPLASTY FOR FEMORAL NECK FRACTURES IN
ELDERLY- EARLY RESULTS OF 42 CASES
Rastogi S, Marya S
Max Superspeciality Hospital, New Delhi, India
Introduction/objectives: Fractures of the femoral neck account for
majority of fractures in the mobile elderly. Cemented arthroplasty is an established
treatment method. However, cementing may cause fatal bone cement implantation
syndrome. Cementless arthroplasty avoids these complications and is a good
alternative in patients with multiple comorbidities.
Methods: Retrospective study of 42 patients with mean age 79 years who
were operated over a 2 year period (August 2010-July 2012) with cementless bipolar
arthroplasty. All patients had some form of comorbidity. Data was collected through
CPRS and PACS hospital system. Data was analysed using statistical software and
Kaplan-Meier survival curve.
Results: Parameters evaluated included duration of surgery, surgical
delay, blood loss, blood transfusion, hospital stay, rehabilitation, perioperative
morbidity and mortality. We had good results in 36 pts. in terms of return to
pre-fracture activity level and independent ambulation. No patient died during
hospitalization. Intraoperatively, 3 had calcar split. 2 patients were lost and 3
died due to unrelated medical conditions during follow-up. Clinico-radiological
evaluation was done at 3, 6, 12 months and yearly for average 24 months. 37 (88%)
patients were followed to final follow-up. All were variably ambulatory. One pt had
stem subsidence, 2 had thigh pain. The mean HHS at 2 years was 85. All patients had
reasonably good outcome except one with stem subsidence.
Conclusions: Cementless bipolar hemiarthroplasty for femoral neck
fractures in elderly permits early return to pre-injury activity level, avoids the
hazards of cementing and is not associated with any untoward cardiac event. It can
be considered as a safe alternative to cemented arthroplasty in this geriatric
patient group.
ePO3-122 BIPOLAR HEMIARTHROPLASTY IN ELDERLY WITH FEMORAL NECK FRACTURE:
SURGICAL APPROACH MATTERS
Salehi N, Mortazavi SMJ, Aminjavaheri S
Tehran University of Medical Science, Joint Reconstruction Research Centre, Tehran,
Islamic Republic of Iran
Introduction/objectives: Femoral neck fractures in elderly patients are
frequent and represent a great health care problem. Traditionally, hemiarthroplasty
for these patients were associated with greater risk of dislocation and
complication. The purpose of this study was to investigate if bipolar
hemiarthroplasty for elderly patients with femoral neck fracture through an anterior
approach was associated with better outcome and less complications comparing to
standard posterior approach.
Methods: During period of January 2010 and January 2013, we did 45
bipolar hemiarthroplasty in 45 elderly patients with femoral neck fracture. We then
compared these group patients with 45 sex and age matched patients who receive
hemiarthroplasty through posterior approach.
Results: The mean age of patients were 73.4 (62-92 years) in anterior
approach group. There were 21 male and 24 female in each of the study and control
groups. Patients in control group receive higher amount of blood transfusion. In
addition, dislocation rate and infection were significantly higher in posterior
approach group. Finally, patients in anterior approach had significantly lower
postoperative hospital stay and ambulated earlier.
Conclusions: Bipolar hip arthropalsty via anterior approach is a viable
option for elderly patient with femoral neck fracture. It is associated with lower
complication rate, hospital stay and faster rehabilitation.
ePO3-273 SIX MONTHS FUNCTIONAL OUTCOME OF HIP FRACTURES IN THE ELDERLY, MID
TERM REPORT
1Department of Orthopaedic Surgery, Inje University, Koyang city, Republic
of Korea (South Korea); 2Uineongbu St. Mary's Hospital, Department of
Orthopaedic Surgery, Uijeongbu City, Republic of Korea (South Korea)
Introduction/objectives: This study is to evaluate and compare mode of
treatments for hip fractures at 6 months after surgery.
Methods: From 2014.10 to 2016.2, 97 patients returning to the outpatient
clinic for 6 months f/u after hip fractures were evaluated. Their activity was
divided into 7 categories (Hiking, use of public transportation, shopping, ability
to stair climbing, work in the kitchen, access to the bathroom, and bed ridden).
Each category compared between preop and at 6 months post operation. Any down grade
in each category were given one point for down grade from free walking to cane or
walker ambulation to ambulation with personal aid and to restricted to wheel chair
or bed ridden. The data were compared to fracture type, mode of treatment, age, and
ASAscore.
Results: Retrospectively reviewed 97 cases of hip fractures, 57
intertrochanteric and 40 neck fracture. Femur neck fracture was treated with
hemiarthroplasty (29), THRA (5) and percutaneous pinning (6). All intertrochanteric
fractures were treated with IM nail and there were 25 A1, 29 A2 and 3 A3 fractures.
The femur neck fractures had better functional outcome than that of
intertrochanteric fractures (functional degradation 5.9/6.5). And in femur neck
fractures, THRA had better outcome than hemiarthroplasty. In intertrochanteric
fracture patients, outcome was poor in unstable fractures (A1-4.58, A2-8, A3-8.33).
Older the patients age, the functional outcome was worse. But, there were no
correlation between ASA score and functional degradation.
Conclusions: Arthroplasty patients had better 6 months functional
results than osteosynthesis by IM nailing. And it should be considered when
informing patients what to expect after hip surgery in the elderly.
ePO3-452 DISLOCATION AND COMPLICATIONS AFTER THR FOR ACUTE FEMORAL NECK
FRACTURES
Turaev A, Cockburn HJ, Fadulemola A, Radhakrishnan A,
Shah N, Wynn Jones H
Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
Introduction/objectives: Primary total hip replacements performed for
femoral neck fractures have a much higher incidence of complications, particularly
dislocation, which in turn is linked to higher mortality figures.
Methods: This was a retrospective review of clinical and radiological
records of patients identified from prospectively collected database specifically
looking at dislocations and other complications from January 2009 to December
2015.
Results: 87 patients with acute femoral neck fractures (female: male
69:18; mean age 70.48 years) deemed to be suitable for primary total hip replacement
as per NICE recommendations underwent 84 cemented and 3 uncemented arthroplasty
procedures using the posterior approach. All surgeries were performed by specialist
hip surgeons. All except 7 cases had a 28 mm metal head. No patient had a
constrained or dual mobility bearing. The 30 day mortality was 0%. 9 deaths occurred
at more than 12 months (10.34%). There was 1 superficial wound infection, no deep
infection and no nerve injury. 3 patients had symptomatic DVT and 1 patient had
symptomatic pulmonary embolism 4 weeks postoperatively. There was one revision
required for a femoral periprosthetic fracture. One patient with recurrent
dislocation despite revision surgery ultimately underwent excision arthroplasty.
There was no mechanical failure of any arthroplasty.
Conclusions: THR in this patient group is shown to have better
functional outcomes and survivorship compared to hemiarthroplasty but is associated
with higher dislocation rates. We found only 1 (1.14%) dislocation despite using
posterior approaches in all patients, and without utilising any form of
anti-dislocation device.
ePO3-91 TOTAL HIP ARTHROPLASTY FOLLOWING FAILED INTERNAL FIXATION OF THE
PROXIMAL FEMORAL FRACTURES
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Centre,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Despite good outcomes of internal fixation (IF)
following hip fractures, some patients experience failure of IF due to several
causes. These problems lead to severe pain and disability and necessitate revision
surgery. Salvage treatment with total hip arthroplasty (THA) can be considered. In
current study, we aimed to investigate the mid- term clinical and functional
outcomes and incidence of complications of THA for patients with failed ORIF of
proximal femoral fractures.
Methods: Between 2004 and 2010, there were 44 patients (31 males, 13
females) with failed IF of previous femoral neck fractures (FNF). The age of the
patients averaged 36.3 ± 16.1 years. The etiology of the failure included avascular
necrosis with collapse in 29 patients, non-union in 9 patients and nail cut-out or
screw breakage with acetabular abutment in 6 patients. Patients were followed for
5.9 ± 3.5 years.
Results: Two patients had died and 5 were lost due to the changing of
the contact information. Intraoperative femoral fracture occurred in one patient.
There was no patient with dislocation, deep venous thrombosis and pulmonary
embolism. Heterotopic ossification was found in 2 patients. Three patients had
developed superficial infection of the surgical wound and were treated with oral
antibiotic therapy. Thirty seven patients returned for last visit. Five patients
complained from mild to severe pain and required analgesics. Three patients could
not ambulate without crutches. Harris hip score averaged 86.7 ± 15.2.
Conclusions: Our findings confirm that THA is an effective and safe
salvage procedure for patients with failed IF of FNF and results in satisfactory
functional and clinical outcomes.
ePO3-154 PRELIMINAR CLINICAL EXPERIENCE OF AN INNOVATIVE DEVICE FOR
PROPHYLACTIC REINFORCEMENT OF CONTRALATERAL HIP FRACTURE
Introduction/objectives: A prevention dedicated osteosynthesis device
(Y-STRUT®, Hyprevention) has been developed to reinforce the
controlateral proximal femur on patients with a high risk of fragility hip fracture.
A multicentre pilot study was initiated to evaluate the safety and effectiveness of
this device and the related operative procedure.
Methods: This clinical study is an on-going prospective series of 15
patients. To date, 5 patients were implanted. Patients were recruited when arriving
to the emergency room following a low-energy trauma leading to a pertrochanteric hip
fracture. Y-STRUT® was implanted into the contralateral hip during the
same surgery as the fractured hip fixation. Clinical evaluation includes OHS and
WOMAC scores, plantar pressure measurements and imagery. Five years follow-up is
planned.
Results: Mean age and BMI of patients were 83 ± 1.7 years and 27 ± 8
kg/m2 respectively. Mean duration of implantation was 54 ± 17 minutes
for Y-STRUT® implantation and 49 ± 24 for hip fracture fixation in the
opposite side. Mean cement quantity was 7cc (6-10) for the studied device. At 3
weeks and 3, 6 and 12 months, comparison between the two legs' plantar pressures
revealed no differences. At 3 months, Womac scores for pain and functionality were 8
and 28 respectively, and 2 and 10 at 12 months. OHS score was 41 at 12 months. No
osteolysis or implant loosening was observed at the different follow-ups. Mean
follow-up is 14 ± 11 months, with one patient who reached 3 years follow-up.
Conclusions: Preliminary results of this prospective study demonstrated
the feasibility and safety of the implantation of this new device. Further data are
required to confirm this experience.
ePO3-32 RISK FACTORS FOR BONE CEMENT IMPLANTATION SYNDROME: A RETROSPECTIVE
STUDY AND A PROTOCOL FOR HIGH RISK PATIENTS
Introduction/objectives: Bone cement implantation syndrome (BCIS) is a
rare but severe peri-operative pathology that presents on cementation of orthopaedic
implants in certain patients and has effects ranging from transient hypotension to
intra-operative cardio-respiratory arrest. We aim to produce a protocol in the
peri-operative management of high risk patients for BCIS.
Methods: We performed a systematic review of the literature on BCIS,
principally in hip arthroplasty, in order to establish known risk factors for this
complication. We also carried out a retrospective study in our institution in order
to identify the mortality rate of cemented arthroplasty involving the femur between
2011 and 2015 and attempted to identify risk factors that our affected patients
shared.
Results: In the case of cemented hip arthroplasty for a fracture, the
mortality rate in our institution was found to be 0.68%, with two deaths directly
attributed to BCIS. When including all highly probable BCIS events during the same
period of time (significant hypotension on cementation leading to multi-organ
failure) this percentage rose to 1.7%.
Conclusions: The mortality rate in our series seems to be higher than
previous published studies. We agree with published literature suggesting that this
pathology may be grossly under-reported and its incidence underestimated. It is
however potentially preventable, especially when high risk patients are identified
pre-operatively. We present a peri-operative protocol for anaesthetists and surgeons
in identifying high-risk patients for BCIS. This proposes several preventative
measures, aiming to reduce mortality and morbidity from this under-reported
complication.
ePO3-23 SHORT TERM RESULTS OF THE USE OF CONSTRAINED ACETABULAR CUP FOR
DISLOCATION OF HEMIARTHROPLASTY OF THE HIP IN ELDERLY PATIENTS
Rajeev A, Banaszkiewicz P
Queen Elizabeth Hospital, Gateshead Health NHS Trust, Gateshead, UK
Introduction/objectives: Dislocation of hemiarthoplasty in elderly
patients is associated with significant morbidity and mortality. The aim of our
study is to assess the short term clinical results of the use of constrained
acetabular cup in dislocation of hemiarthroplasty of hip.
Methods: A retrospective review of dislocated hemiarthroplasty of hip
for a period from 2009 to 2013 is carried out using coding data base, theatre
records and case notes. We identified cases with dislocation of hemiarthroplasty who
underwent revision surgery using constrained acetabular cup. Cemented cups were used
in all the cases.
Results: There were a total of 672 patients had hemiarthroplasty during
this period. Twenty-five (3.72%) patients had dislocation of hemiarthropalsty.
Seventeen patients had Thompsons and eight patients had ETS hemiarthroplasty. Six
patients had revision of hemiarthroplasty to a total hip replacement using
constrained acetabular cup and 44 offset CDH Exeter stem with cement to cement
fixation. All the patients had a good postoperative recovery. All patients were
mobilised and discharged early. There were no complications including infections,
deep vein thrombosis, pulmonary embolism or further dislocation at one year
follow-up.
Conclusions: The advantages of using constrained acetabular cups are it
avoids prolonged bed rest and also the use of an abduction brace and also allows
rapid rehabilitation. We conclude that the revision of a dislocated hemiarthroplasty
using constrained acetabular cup and cement to cement Exeter stem is a good option
in selected group of patients with good clinical outcomes.
ePO3-197 ARTHROSCOPIC LABRAL REPAIR VERSUS LABRAL DEBRIDEMENT IN PATIENTS WITH
FEMOROACETABULAR IMPINGEMENT: A MINIMUM 2.5 YEAR FOLLOW-UP STUDY
Introduction/objectives: To compare the clinical results of labral
repair with labral debridement in patients undergoing arthroscopy for
femoroacetabular impingement.
Methods: Between July 2008 and December 2011, 67 patients (73 hips)
underwent arthroscopic treatment for femoroacetabular impingement. The repair group
consisted of 33 patients; 18 hips with pincer only, 1 with CAM only and 15 with
combined impingement. The debridement group contained 34 patients; 6 with pincer
only, 5 with CAM only and 28 with combined type. The mean age in the repair group
was 33.5 years (range, 30-61) and in the debridement group was 39.5 years (range,
18-59 y). At the time of last follow-up, patient's hip function was evaluated with
ROM of the hip; daily Hip Outcome scores (dHOS) and Visual Analogue Score (VAS).
Results: The mean follow-up was 45.2 month in the repair group and 47.2
month in debridement group. Daily hip outcome scores were significantly improved
from pre-operatively to last follow-up in both groups (p<0.05). However, there
were no statistical significant difference in dHOS between repair and debridement
groups (p>0.05) at last follow-up. 2 patients in the repair group and 1 patient
in the debridement group had undergone total hip replacement at an average of 16
months (range, 4-32 m) after arthroscopic treatment. Hip joint instability occurred
in 1 patient in the repair group due to aggressive capsular resection. This was
treated by a periacetabular osteotomy.
Conclusions: No difference in hip functional outcomes was observed
between labral debridement and labral repair in arthroscopic treatment of
femoroacetabular impingement.
ePO3-214 PUBLICATION RATE OF ABSTRACTS PRESENTED AT THE 11TH EUROPEAN HIP
SOCIETY CONGRESS
Introduction/objectives: Academic meetings provide forums for education,
discussion and presentation of studies. To enable wide-spread dissemination of
information full peer-review publication is required. The objective of this study
was to determine the rates of publication after presentation of abstracts in
11th European Hip Society Congress (EHS).
Methods: We screened all abstracts from Hip Int 2014;24(5):493-545. We
used the PubMed, Google Scholar and Web of Science databases to search for
subsequent publication of abstracts. The publication rate, average time between
congress presentation and publication, and journals name for the corresponding
articles was examined.
Results: There were 205 abstracts in the 11th EHS Congress.
22 of the 205 abstracts (10%) were followed by publication of an article before the
congress. 35 of the 205 (17%) abstracts were published as an article after the
congress. Most of the articles published in Hip International (n = 11), The Journal
of Arthroplasty (n = 10) and Acta Orthopaedica (n = 6) journals. Abstracts were
published as an article at average of 7.85 ± 4.05 months after presentation in 21
journals. 7 abstracts from “The best 9 abstracts” were published as an article.
Conclusions: Rates of publication of complete papers following
presentation of abstracts at international meetings have ranged from 11% to 78%.
Given that two-thirds of the abstracts in our study have still not been fully
published, caution should be exercised when translating information presented at
meetings into orthopaedic practice. Also, if a report published to demonstrate the
publication rate of abstract presented at the previous congress, it may increase the
publication rate of abstract. More careful review for abstract (by congress
scientific committee) may motivate all researchers.
ePO3-254 LINKING SWEDISH HEALTH DATA REGISTERS TO ESTABLISH A RESEARCH
DATABASE. ADDING AN EXTRA DIMENSION TO THE SWEDISH HIP ARTHROPLASTY
REGISTER?
1Swedish Hip Arthroplasty Register, Centre of Registers Västra Götaland,
Gothenburg, Sweden; 2Department of Orthopaedics, Institute of Clinical
Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
3Medical Management Centre, Karolinska Instituted Solna, Sweden;
4Department of Orthopaedics, Lund University, Malmö University
Hospital, Malmö, Sweden; 5Department of Orthopaedics, Hywel Dda
University Health Board, Prince Philip Hospital, Llanelli, UK; 6Hip Unit,
Princess Elizabeth Orthopaedic Centre, Royal Devon & Exeter Hospital, Exeter,
UK
Introduction/objectives: In recent years, SHAR has reported 95% ten-year
implant survival. Demography and other patient-related factors routinely collected
by the register are limited. The richness of other health data registers in Sweden
and the unique personal identity number (PIN) enable linkage of different data
sources making analyses of the impact of socio-economic and other health-related
factors on the outcome of hip arthroplasty possible. Here, we aim to describe the
process of establishing such research database.
Methods: Using the unique PIN, assigned at birth (or immigration) for
every Swedish resident, the databases of the Swedish Hip Arthroplasty Register,
Statistics Sweden and the National Board of Health and Welfare were merged and the
patient identifier removed.
Results: Data from 279,173 primary procedures in 230,424 patients and
16,501 reoperations in 15,842 patients operated from 1992-2014 comprise 96 gigabytes
in 79 files. Data are stored on encrypted servers that can only be accessed by
researchers involved in the project. Data were structured by statisticians and
underwent a series of validation processes. Of the total potential number of
patients (279,173) only 59 (0.0002%) were lost during the process.
Conclusions: This database is the starting point of several research
projects identifying factors that influence the outcome of hip arthroplasty.
Socioeconomic factors, primary diagnosis and comorbidities are affecting the
outcomes and a clinical validated instrument to help the decision-making between the
patient and healthcare providers could well be developed as a result of the
identification of risk factors, based on a review of a large dataset.
eP04 Revision THA
ePO4-401 IMPORTANCE OF PROPER PLACEMENT OF IMPLANTS IN HIP ARTHROPLASTY
Martinez-Esoinosa M, Donaire-Hoyas D,
Albert-Ullibarri A
Hospitalde Poniente, Hip Unit, El Ejido, Spain
Introduction: We report the case of a 77-year-old patient having an
uncemented total hip arthoplasty with retentive acetabulum. He had a history of
several episodes of posterior dislocation of the hip, which had been resolved by
performing orthopaedic reductions, polyethylene replacement, using a dislocation
prevent necklace and finally proceeded to the placement of a retentive acetabulum.
The patient comes to our emergency department for the first time, presenting a type
IV dislocation of the acetabular implant.
Methods: Our imaging studies show a very retroverted acetabulum and
despite being retentive, do not respect the hip joint biomechanics, producing an
inadequate transmission of loads, which has led to the failure of the implant. It
intervenes surgically removing the retentive acetabulum and placing a dual mobility
acetabulum in a more anatomical and congruent position relative with the femoral
implant.
Results: In the immediate postoperative period, the patient had a
significant improvement in pain wandering around with two crutches from 48 hours to
6 weeks post intervention. One year after the operation, the patient has no signs of
hip stability, walking without aid, with the scale of Harris 90,65/100 and Womac
89.5/100.
Conclusions: When a hip replacement is performed correctly, many systems
are available to prevent dislocation of it and get an apparent stability. But this
case shows that despite using these systems, if implants are not placed correctly
biomechanically sooner or later a failure will occur.
ePO4-298 CONVERSION FROM HIP JOINT ARTHRODESIS INTO TOTAL HIP REPLACEMENT IN
YOUNG ADULTS: ASSESSMENT OF RESULTS
Sionek A, Czubak J, Czwojdzinski A, Grochowski
K
Department of Orthopaedics, Paediatric Orthopaedic CMKP, Warsaw, Poland
Introduction/objectives: In the past decades, one of the accepted
methods of operative treatment of young adults with osteoarthritis (OA) coming as
the sequeleae of congenital hip dislocation, was hip arthrodesis. Recently, a
dynamic development of total hip replacement (THA) was observed. Due to the
increasing expectations concerning life quality of this group, conversions from hip
arthrodesis to THA are performed more often. Conversion is difficult and carry an
increased risk of complications. The aim of this study was to assess the early
results of conversion from hip arthrodesis to THA.
Methods: In years 2011-2015 we treated 10 hips of 10 patients, who had
formerly performed hip arthrodesis. All evaluated patients have undergone numerous
hip-joint operations in their childhood. In the group, there were 9 female and 1
male of the age from 15 to 39 years (mean 20 years). Conversions were performed from
posterior-lateral approach. To all patients, the Varial shell and Wagner cone stem
were implanted. The follow-up period lasted from 1 to 5 years (mean 3 years).
Results: Results were assessed clinically according to the Harris'
classification and the osteointegration of endoprothesis was assessed
radiologically. The type, frequency and duration of complications were noted.
In clinical assessment, improvement was observed in 9 patients. In one case
intraoperative pelvic fracture occurred. In radiological assessment, no
characteristics of shell and cone stem loosening were noted. In 3 patients,
transient sciatic nerve paresis occurred, which subsided in the period from 2 to 16
months after the operation.
Conclusions: The results we have obtained are encouraging and coincide
with the results of studies by different authors.
ePO4-225 CERAMIC INSERT FRACTURE IN CEMENTLESS THR WITH MODULAR NECK, CERAMIC
ON CERAMIC
Peirano F, Canale C, Varas G, Ortiz C
Complejo Medico Policial Churruca-Visca, Buenos Aires, Argentina
Introduction/objectives: The use of ceramic on ceramic friction pair
(CC) in THR has increased due to its tribologic characteristics, less wear and low
reaction on the particles. However, other problems have appeared, like the squeaking
and breaking of its components. We present a case of fracture of the ceramic insert
in one cementless THR of modular femoral neck, with ceramic head and the
solution.
Methods: The patient is a 46 year-old female. Cementless right THR in
2012 due to coxarthrosis. Cup 56 ceramic insert, stem 2 long neutral modular neck,
short ceramic head. The X-ray, with a notable increase of the inclination and lack
of anteversion of the cup. Good evolution until a squeaking began 16 months later,
initially painless but becoming symptomatic and very audible. Fracture of the
ceramic acetabular component was discovered, reason for which revision was done of
cup, insert and femoral neck and head.
During surgery a great amount of fragments was observed, spread out and contained in
reactive tissue. Taking advantage of the modularity of the neck and of the fact that
it remained fixed, the stem was preserved.
Results: Revision was realised in 1-Stage Exchange Arthroplasty, cup,
liner, neck and head. Taking advantage of the modularity of the neck and of the fact
that it remained fixed, the stem was preserved.
Conclusions: Bibliography reports a survival of 68% to 84% at 20 years
in the first generations of CC, and 92% to 99% at 10 years in the new designs. The
reported case highlights the importance of a correct positioning of both components
(in agreement with the literature), to avoid the risk of fracture and the
development of squeaking.
ePO4-64 AN UNUSUAL PHENOMENON SEEN AFTER CERAMIC-ON-CERAMIC TOTAL HIP
REPLACEMENT: CASE REPORT
Kivrak A1, Unlu MC1, Terzi
E1, Botanlioglu H1, Kaynak G1, Pirincci
Y2, Can A3
1Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey;
2Istanbul Medicine Hospital, Istanbul, Turkey; 3Istanbul
Cerrahi Fulya Hospital, Istanbul, Turkey
Case study: In this article we will report a case of squeaking due to
fractured ceramic liner after ceramic-on-ceramic (CoC) total hip replacement (THR).
Our patient was a 57-year-old male who received a left uncemented THR with a CoC
bearing. Approximately 2.5 years postoperatively, the patient developed squeaking in
his operated hip. The squeaking was loud and occurred with every step. There was no
history of trauma. His body mass index (BMI) was 28kg/m2. The left hip
flexion was 120°. Radiographs revealed an acetabular inclination angle of 48°. This
sound was negatively affecting his life and a broken liner is thought to be the
reason of that sound, revision of THR was recommended. One week before the
operation, the sound disappeared and a broken acetabular liner was detected in
control radiographs. Then the patient was operated. Pre-Operatively, there was
widespread metallosis around the prosthesis, ceramic femoral head was intact and the
ceramic liner was broken. There were no impingement findings. Broken ceramic
particles were removed from the surgical field. The field was washed with
compressive pulsatile washing system, the acetabular component wasn't removed due to
the well fixation and abrasion of the head of the screw used in fixation of the
acetabulum, cemented polyethylene liner was applied and the femoral head was
replaced with an oxinium head. After the reduction of the joint, left hip range of
motion was stable. The patient has no complaints in the postoperative 4th
month. In the CoC THR, head and liner exchange to a metal-on-highly cross-linked
polyethylene is an effective method to eliminate squeaking. Due to low complication
and abrasion rates of CoC joint surfaces, it can be used successfully in appropriate
patients.
ePO4-52 LONG-TERM OUTCOME OF A MODULAR HEAD ADAPTER SYSTEM IN REVISION HIP
ARTHROPLASTY FOR MULTIMORBID PATIENTS
Introduction/objectives: Recurrent dislocation of THA in multimorbid
patients remains challenging for the future. The objective of this retrospective
study was to document reliable long-term data after operative treatment of this
typical complication by using a modular head adapter system.
Methods: A multimorbid collective of 19 patients (10F, 9M; mean age
69[50-98]) with dislocating THA was treated operatively with a modular head adapter
system in 2003-2004. All patients were followed-up clinically after 1,7 and 10 years
using Oxford Hip Score, Barthel Index and health related quality of life (NHP and
EQ-5D) as well as evaluation of patient medical records and re-exam of all surviving
patients.
Results: In this multimorbid patient group in-hospital mortality was
8.7% (n = 2). After a mean survival period of 96 (12-144) months 78.9% (n = 15) of
the patients had died mainly due to cardiopulmonary reasons. 10.4% (n = 2) patients
underwent further total hip revision surgery due to recurrence of THA dislocation.
After discharge 17 of 19 patients (89.5%) were mobile with a Barthel-Index of 88
that did not change significantly during the follow-up period. Patients with
ASA>3 evidenced a significant higher rate of mortality (p = 0.04) and a
significant worse level of activity (p<0.01). Quality of life statistically
showed no significant differences to comparable treatment groups in the
literature.
Conclusions: Recurrent THA dislocation rates in multimorbid patients
remain a surgical challenge in a fast growing geriatric population. We conclude from
our 10-year-follow data that implanting a modular head adapter system in multimorbid
patients is safe and effective in the long-term to prevent recurrent THA dislocation
without exposing these patients to the high operative risks of major total hip
revision surgery.
ePO4-61 ANTERIOR FEMORAL OSTEOTOMY FOR REVISION HIP ARTHROPLASTY
Janipireddy S
North Middlesex University Hospital NHS Trust, London, UK
Introduction/objectives: Revision arthroplasty poses many challenges in
safe removal of cemented or uncemented femoral component and/or distal cement
particularly from a poor bone stock. The three well described techniques are the
standard trochanteric osteotomy, the trochanteric slide and their modifications.
However, all these techniques are associated with non-union, trochanteric migration,
wire breakage and difficulties associated with reattachment of the fragment.
We present a previously undescribed technique of trochanter sparing extended anterior
femoral osteotomy (AFO) through a modified Hardinge approach.
Methods: All cases of revision hip arthroplasties utilising the AFO
technique from 2004 performed by single surgeon were reviewed. Clinical and
radiographic assessments of 23 patients with a mean follow-up of 5.4 years (range
1-9 years) were performed.
Results: No trochanteric escape or trochanteric fractures seen in any
cases. No proximal migration, subsidence or failure of femoral component seen. Union
was seen in all but 2 cases; fibrous non-union seen in 1 patient. Mean time for
union was 6 months (3-7 months). One intra-op fracture during hip reduction. 1
patient developed recurrent dislocation that required change of socket liner.
Improvement in Harris Hip scores was noted from 13 (pain) and 9 (function) pre-
operatively to 39 (pain) and 22 (function) (p<0.05).
Conclusions: AFO allows extensive exposure similar to traditional ETO.
It heals reliably without the use of vertical wires, trochanteric plates or grips.
The avoidance of abductor mechanism and osteotomy through weakest anterior non
weight bearing area of the proximal femur may be a significant advantage.
ePO4-314 FEMORAL REVISION HIP ARTHROPLASTY: A MODULAR STEM IN MEDIUM
TERM
Garcia P. Sousa Filho P, Garcia P, Kimura O, Freitas
E, Fernandes M
Institute Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: Strategies for the revision of the femoral
implant are based on the quality and quantity of remaining bone. The modularity
offers the advantage of using the proximal and distal variable geometry, improving
fixation of the implant and facilitating the restoration joint kinematics. Other
advantages of this implant are able to repair the femoral anatomy and restoration of
lateral offset. The aim of this study was to evaluate the outcomes of revision
arthroplasty using modular femoral stem in medium term.
Methods: We conducted a longitudinal, descriptive and prospective study
to evaluate the femoral revisions with a modular stem. All patients underwent
revision total hip arthroplasty between June 2007 and March 2013. The posterolateral
approach was used in all cases, with or without trochanteric osteotomy extended.
Results: In 62 surgeries, the main cause of revision was aseptic
loosening (70.9%), followed periprosthetic fracture (22.5%). The mean age was 61
years (30-83 years). The pre-operative bone defect was evaluated according to the
classification of Paprosky, being the most common type IIIA (50%). Type I, II, and
IIIB represented 12.9%, 25.8% and 8%, respectively. Minimum follow-up was 36 months
and the median time was 66 months. No osteolysis or implant migration was observed
in any patient. Major complications included dislocation of the prosthesis (8.0%)
and acute infection (3.2%). There was no breakage of the implant.
Conclusions: Recent studies show that the fracture of the implant is a
catastrophic complication, although infrequent, around 1%. Thus, despite the
modularity enabling various types of settings, does not appear to be effective in
reducing of complications, especially dislocation/instability complications.
ePO4-60 REVISION THA WITH IMPACTED BONE ALLOGRAFTS AND CEMENTED LUBINUS SP II
STEM
Ullmark G, Stigbrand H
Orthopaedic Department, Gävle, Sweden
Introduction/objectives: Revision of a loosened THA often includes
dealing with bone loss caused by osteolysis and stem loosening. The method to regain
bone loss secondary to osteolysis is impaction of morcellised bone graft (IBG). This
study describes the technique for femoral IBG adapted to the Lubinus SP II stem
together with a clinical 6 years follow up of 70 cases with severe osteolysis.
Methods: 71 femoral revisions in 69 patients consecutively operated with
revision femoral arthroplasty using IBG and a cemented Lubinus SP II stem was
identified. The mean age was 69 (29-94) years. Six (1-18) years after surgery we
retrospectively analysed 70 of the cases (one was lost to follow up). At time of
surgery, all had substantial femoral bone loss, classified according to Endo Klinik
classification. 16 cases were in class IV, 47 in III and 7 in class II. The patients
were analysed by clinical score and radiography.
Results: At follow up 5 cases (7%) had been re-revised for mechanical
loosening, non for infection or any other reason. Radiological and clinical results
were excellent for the analysed patient.
Three (4%) had been reoperated for a periprosthetic fracture in distal femur.
Conclusions: The method of IBG combined with the Lubinus SP II stem
is safe and resulted in good medium term result and a regain of living bone for this
challenging condition.
ePO4-94 DUAL MOBILITY CUPS FOR RECURRENT DISLOCATION OF TOTAL HIP
ARTHROPLASTY
Taheriazam A1, Safdari
F2
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Bone, Joint and Related Tissues Research Centre,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Instability following total hip arthroplasty
(THA) is a serious disabling complication. Even revision THA due to the recurrent
dislocation can be associated with persistent instability. Dual mobility implants
(tripolar prosthesis) are used to reduce the risk of recurrent hip dislocation.
However, there is little knowledge about the mid-term and long-term outcomes of
using these implants. We evaluated the midterm results of treating recurrent THA
dislocation using tripolar prostheses.
Methods: Between 2005 and 2011, 24 consecutive patients were revised due
to recurrent hip dislocation. The patients aged 62.4 ± 10.6 years at the time of
surgery. All of the patients had at least 2 episodes of dislocation. Pre-Operative
Harris hip score (HHS) was 46.1 ± 11.5. Patients were followed for 6.2 ± 4.1
years.
Results: At the last visit, HHS improved significantly (83.5 ± 12.6,
p<0.001). Redislocation occurred in one patient who required a further revision
surgery (4.1%). No patient developed infection and or symptomatic deep venous
thrombosis. Also, we found no patient with implant loosening or periprosthetic
fracture.
Conclusions: Tripolar hip prostheses are useful and effective for
treatment of patients with recurrent hip instability after THA. However, more large
long-lasting prospective studies are required.
ePO4-332 REVISION TOTAL HIP ARTHROPLASTY FOR METAL-ON-METAL DEVICES: BLOOD
MANAGEMENT AND EFFICIENCY OF AN ORTHOPAEDIC AUTOTRANSFUSION SYSTEM
1Medizinische Universität Graz, Univ. Klinik für Orthopädie, Graz,
Austria; 2Medizinische Universität Graz, Abteilung für Anästhesiologie
und Intensiv-medizin, Graz, Austria
Introduction/objectives: Patient's blood management became the focus of
attention due to the increasing numbers of arthroplasties with the intent to
minimize costs. The aim of this series was to analyse the efficiency of an
autotransfusion system concerning clearance of metal ion concentrations used during
revision arthroplasty of metal-on-metal devices.
Methods: Three patients underwent revision total hip arthroplasty due to
wear of the polyethylene-metal sandwich inlay and the metal head after an average
follow-up of 187 months (range, 143-212).
Metal ion concentrations were determined pre-operatively in the serum and in the
puncture specimen. Perioperatively, blood was collected using an autotransfusion
system with an integrated percolation system. Blood was obtained from collection bag
before and after filtration and analysed for Co and Cr concentrations.
Results: The mean pre-operative serum Co and Cr concentrations were
24.14 yg/L (range, 0.04-71.70) and 17.78 yg/L (range, 0.59-51.31), respectively,
whereas the mean local concentrations in the aspiration fluid were 100-fold and
255-fold higher (mean: Co: 2451.26 yg/L and Cr: 4542.68 yg/L), respectively.
Pre-filtration, the Co and Cr concentrations were 5.68yg/L (range, 0.94-11.80) and
468.61 yg/L (range, 8.76-1383.0), respectively, and after filtration, the metal ion
levels decreased markedly to mean concentrations of 0.66 yg/L and 46.09 yg/L for Co
and Cr (Co: p = 0.127, Cr: p = 0.275).
Conclusions: Several studies showed that intraoperative cell salvage
reduces allogenic blood transfusion and infection rates. The current series showed
that in case of revision of MoM hip devices an autologous blood retransfusion is not
recommendable due to the fact that metal ions are still contained in the collected
blood after filtration and wash out.
ePO4-397 LONG TERM RESULTS OF ACETABULAR RECONSTRUCTION WITH MUELLER
REINFORCEMENT RING
Maeda A
Showa University Northern Yokohama Hospital, Yokohama, Japan
Introduction/objectives: Muller acetabular reinforcement ring is one of
the popular implant for acetabular reconstruction. Since 1990 we have started to use
this implant for acetabular reconstruction with morcellised bone allograft.
Methods: Between December 1990 and December 1994, total 57 rings (54
patients) were used for revision surgery in our institution. Mean age at the surgery
was 59 (31-78). 11 patients died during follow up and 13 patients were lost to
follow up. 31 joints (30 patients) could be evaluated by direct medical examination
after January 2010. Average follow up period for these patients was 17Y10M.
Results: There are no breakage of the rings and ring-inlay interfaces. 2
patients went to re-revision surgery by acetabular side loosening. 5 patients went
to re-revision by stem loosening. Mean Japan Orthopaedic Association Hip score was
78.8 points at post-operative one year and 72.9 at the last follow up. Radiolucent
lines according to DeLee and Charnley were observed 2 joints in zone 2 and 4 joints
in zone 3.
Conclusions: Results of acetabular reconstruction with mueller ring is
acceptable. Procedure is relatively simple, and long-term results can be
expected.
ePO4-68 CUP CCGE RECONSTRUCTION FOR MASSIVE ACETABULAR DEFECTS AND PELVIC
DISCONTINUITY
Fraile Suari A, Marqués López F, Tey Pons M, Cuenca
Llavall M, León García A
Hospital del Mar l'Esperança, Barcelona, Spain
Introduction/objectives: Reconstruction after failure of the acetabular
components in total hip arthroplasty with massive acetabular defects and pelvic
discontinuity is a complex surgery with important difficulties for the orthopaedic
surgeon. The aim of this study is to show the short and midterm results of the
acetabular revision with the Cup Cage construct in a consecutive series of cases
with massive acetabular defects and pelvic discontinuity.
Methods: Retrospectively we reviewed 11 consecutive patients, with a
minimum follow-up of one year, with massive acetabular defects and pelvic
discontinuity. 8 cases presented with massive acetabular defects (Paprosky type 3B);
2 cases got a pelvic fracture during the impactation of the acetabular component of
a primary total hip arthroplasty; and the last one got a pelvic pseudoarthrosis. All
the cases were reoperated with a trabecular metal acetabular component and a Cup
Cage reconstruction cage to improve the initial stability of the implant.
Results: With a middle follow-up of 45.06 months (range 12-73 months) we
did not see any radiographic failure of the implant. Complications included one
recurrent luxation, one prosthetic infection and one liner loosening without
affecting the Cup Cage for a mistake during the initial cementation. The postel
Merle-d'Aubigné score improved from 8.91 to 14.36 and the punctuation in the range
of motion from 2.91 to 4.36 on average of the values pre-operatively and
postoperatively respectively.
Conclusions: The acetabular reconstruction with the Cup Cage system is a
valid alternative for the reconstruction of massive acetabular defects (Paprosky
type 3B) and pelvic discontinuities offering good results at short and midterm
follow-up.
ePO4-106 ACETABULAR REVISION ARTHROPLASTY BY PINNACLE GRIPTION REVISION CUP,
AUGMENTS AND CHRONOS VIVIFY ALLOGRAFTS WITH PRP/MSCS
Zanasi S
Villa Erbosa Hospital, San Donato Group, Bologna, Italy
Introduction/objectives: The GRIPTION TF material is a completely porous
structure made from commercially pure titanium which makes allowance for immediate
stability, good bone tissue ingrowth and vascularisation onto and around an implant.
The aim of this study was to evaluate early results of acetabular revisions of THR
using fully cementless Pinnacle Gription revision cup, augments and Chronos vivify
allografts embedded in PRP/MSCs.
Methods: Between 3/2012 and 2/2015 Pinnacle Gription revision cup was
used in 59 consecutive acetabular revisions. The augments were used in 19 cases. The
mean age at revision was 68 years (32-84 years). There were 6 patients revised for
type 1, 8 for type 2A, 16 for type 2B, 8 for type 2C, 10 for type 3A and 11 for type
3B acetabular defects, according to the Paprosky classification. Frozen morselised
bone omografts were used in 33 cases and Chronos allografts with PRP/MSCs in
twenty-three cases.
Results: The mean pre-operative HHS functional score was 47 and 81 at
the time of last follow up. There was two revisions due to instability of the
acetabular component. Two cases with Paprosky type 3B defect showed cranial
migration of the acetabular component by 6 mm, but stabilised after six months. In a
2 to 3-year follow-up, 86% of the shells showed no radiolucent lines. Of 14 hips
with postoperative radiolucencies, seven had cleared by the last follow-up, while
one had increased. Average VAS for postop. pain was 12; the median postop HOOS at
last follow up was 74.
Conclusions: Pinnacle Gription revision cups, hemispherical modules and
augments facilitate reliable and reproducible biological fixation in acetabular
revision surgery with excellent results. Extended follow-up is necessary to evaluate
the long-term performance of these modular implants.
ePO4-165 THE MANAGEMENT OF SEVERE ACETABULAR BONE DEFECTS IN REVISION HIP
ARTHROPLASTY: BURCH-SCHNEIDER CAGE
Tikhilov R, Shubnyakov I, Tsybin A, Denisov A,
Karpukhin A
Vreden Russian Institute of Traumatology and Orthopaedics, S. Petersburg, Russian
Federation
Introduction/objectives: Acetabular reconstruction in hip revision
surgery with massive bone loss is a disputable issue on a global scale.
Burch-Schneider cage has 35 years' experience and about 125000 implantations around
the world.
The aim of this study was to analyse mid-term results of 56 Burch-Schneider cage
implantations in acetabular revision surgery.
Methods: We investigated mid-term results of 56 acetabular
reconstructions (56 patients) associated with major bone loss. The series included
18 men and 38 women with a mean age of 53 years (37 to 85). There were 2.6 (1-6)
previous revisions. In 42 cases there were isolated acetabular revisions and in 14
cases were total revisions. There were 6 cases (10.7%) of 2C, 26 (46.4%) - 3A and
24-3B (42.8%) defects according to Paprosky classification. In 42 cases (75%) we
used allografts to fill acetabular defects: in 33 cases (78.6%) we used bone chips,
in seven (16.7%) - structural allografts, in two (4.8%) - massive osteochondral
ones. We used X-ray examination and functional scales to evaluate mid-term results
(Roman software, Harris Hip Score and Oxford Hip Score).
Results: The mean follow up was 64.3 months. The mean Harris hip score
improved from 23.6 to 71.8, Oxford hip score at the final follow up was 36.2. In 47
cases (84%) good clinical and radiological results. In nine patients (16%) were
failures: two cases aseptic loosening and in seven periprosthetic infection.
Conclusions: Burch-Schneider cages implantation in patients with severe
acetabular bone loss is a reliable option which shows good mid-term results.
Especially for young patients, the use of morsalized allograft with Burch-Schneider
Cage promotes restoration of the bone.
ePO4-403 RECONSTRUCTION OF MASSIVE ACETABULAR DEFECTS USING ALLOGENEIC
CANCELLOUS BONE GRAFT AND A BURCH-SCHNEIDER RING
Santos Leite P, Neves P, Barreira P, Serrano P, Ramos
J, Coelho R, Costa e Castro J, Lemos R
Centro Hospitalar do Porto, Porto, Portugal
Introduction/objectives: Reconstruction of severe acetabular bone
defects is a challenging problem, especially when associated with pelvic
discontinuity. The use of morselized allograft combined with an anti-protusion cage,
provides immediate mechanical fixation and has the potential for restoration of bone
stock. The aim of our study was to evaluate the clinical and radiographic results of
a series of patients with severe acetabular defect (type III/IV AAOS) submitted to
reconstruction with morselised allogeneic bone graft and a Burch-Schneider ring.
Methods: We performed a retrospective study including 23 acetabular
revisions (22 patients) due to aseptic loosening with severe acetabular defects (16
type III and 7 type IV). Mean age at surgery was 68 y, including 16 women and 6 men.
All patients were available for follow-up at an average of 48 months (24-92).
Results: HHS went from a preop mean of 38 (23-58) to 77 (53-96)
(p<0.05). Two patients were submitted to Girdlestone procedure due to deep
infection (8.7%); and two had new revision surgery because aseptic migration of the
implant (8.7%). Complications also included one case of deep venous thrombosis and a
common peroneal nerve neuropraxia. The centre of rotation was in anatomic position
in 17 of the reconstructions (73.9%) in the last evaluation and concerning the
subjective clinical outcome, 15 patients were satisfied or very satisfied
(65.2%).
Conclusions: Our experience with this strategy was very satisfactory.
Although a relevant number of patients required further surgical revision, we
observed a significant clinical improvement in this series. Treating severe
acetabular defects is technically demanding and the best method of revision remains
unclear. Pre-Operative planning and accurate surgical technique are crucial.
ePO5 THA
ePO5-70 CHANGE IN FEMORAL NECK ANTEVERSION RELATIVE TO THE RETROCONDYLAR
COORDINATE SYSTEM AND COMPUTED TOMOGRAPHY AXIAL PLANE
Imai N1, Dai M2, Hirano
Y3, Suzuki H2, Endo N2
1Department of Comprehensive Geriatrics, Niigata University, Niigata,
Japan; 2Niigata University, Niigata, Japan; 3Niigata
Prefectural Tokamachi Hospital, Tokamachi, Japan
Introduction/objectives: Femoral neck anteversion (FNA) is usually
measured during the planning for stem anteversion prior to total hip arthroplasty
(THA), the evaluation of stem anteversion after THA, and planning for valgus
osteotomy with derotation. Hence, the accurate measurement of the FNA is vital. To
ensure such accurate measurements, it is preferred that FNA is measured using a
standard coordinate system.
We used the CT scan of a 38-year-old woman who presented to our institution for the
evaluation of femoroacetabular impingement.
Methods: We compared the differences between true value of FNA, which
was relative to the retrocondylar plane, and those from each three-dimensional
femoral model with computer simulation. Moreover, we evaluated certain parameters,
including the morphological and positional factors that affected the measured
values.
Results: We observed that the measured FNA values increased with an
increase of each degree of extension and adduction. Moreover, in cases where the
neck shaft angle was larger, the measured FNA values tended to increase more. The
maximum discrepancy between the true value and measured value was 15.8°, whereas the
largest difference between the maximum discrepancy and minimum discrepancy of the
fixed neck shaft angle and FNA was 25.8°. In cases where the femur has a high neck
shaft angle (valgus hip) and/or high anteversion, it is likely that the measured
value is smaller than the actual value.
Conclusions: It is essential to carefully consider the discrepancy of
the measured value when the FNA is measured from the CT axial plane without any
correction according to the retrocondylar plane.
ePO5-262 TOTAL HIP ARTHROPLASTY IN A PATIENT WITH SYSTEMIC MASTOCYTOSIS
Santos Leite P, Neves P, Barreira P, Serrano P, Silva
M, Barros L, Esteves J, Cardoso P
Centro Hospitalar do Porto, Porto, Portugal
Case study: A 38-year-old male with Systemic Mastocytosis (SM) was
referred to our outpatient clinic with severe pain in the left hip, especially on
weight-bearing. Systemic Mastocytosis was diagnosed 18 years previously. He had
urticaria pigmentosa skin lesions and signs of bone marrow infiltration including
bruising, bleeding and anaemia. Physical examination revealed an antalgic gait and a
decreased range of motion without flexion deformity (flexion −90°; abduction −15°;
adduction, internal rotation and external rotation −10°). There was no limb length
discrepancy. The Harris Hip Score (HHS) was 48 of 100 (poor). Anteroposterior pelvic
radiograph showed diffuse sclerosis and the medullary canal seem obliterated.
Obvious features of osteoarthritis were present in the left hip.
The general condition of the patient was good and the life expectancy was considered
reasonable, therefore a cemented THR was performed (posterior approach). We observed
significant bleeding from the soft tissues. The femoral neck osteotomy was done
without any trouble but the definition of the medullary canal was difficult, whereby
the preparation of the femur was done using fluoroscopy. The implantation of the
acetabular component ran smoothly. Histological examination of the marrow component
showed an increase in the cellularity with multifocal, sharply demarcated, compact
infiltrates of MCs consistent with the disease. The patient had an uneventfu
postoperative course. With three years of follow-up, he has a normal gait; slight,
occasional pain, with no compromise in activity; HHS 96 of 100 (excellent). There
are no radiological signs of loosening. To date, there are only two cases reported
in the literature of patients with SM undergoing THR.
ePO5-221 THE RESULTS OF TOTAL HIP ARTHROPLASTY FOR TUMORS OF THE PROXIMAL
FEMUR
Protsenko V, Chorneyi V, Duda B
Institute of Traumatology and Orthopaedics of NAMS of Ukraine, Kiev, Ukraine
Introduction/objectives: Tumours of the proximal femur account for about
15-25% in the structure of the bone lesions. One of the main methods of organ
treatment of patients with malignant bone tumours is arthroplasty. Arthroplasty
allows you to save not only the life of the patient, but also a functioning
limb.
Methods: Hip arthroplasty was performed in 21 patients with primary and
metastatic tumours of the proximal femur. Primary bone tumours observed in 12
patients (chondrosarcoma - 7, osteogenic sarcoma - 3, giant cell tumour - 2),
metastatic tumours - 9 (metastasis of breast cancer - 4, metastatic cancer of the
kidney - 3, metastasis of prostate cancer −1, myeloma - 1). Functional evaluation of
the operated limb was performed by MSTS scale. The quality of life of patients was
determined in points (questionnaire QLQ-C30EORTIC).
Results: Postoperative complications were detected in 5 (23.8%)
patients. Tumour recurrence - in 1 (4.76%) patient. Functional outcome after limb
arthroplasty (MSTS scale) was 72.4%. The quality of life of the patients improved
from 40 points pre-operatively to 80 points after the arthroplasty.
Conclusions: The use of methods of hip replacement in the combined and
complex treatment of patients with tumours of the proximal femur can restore
function and support ability of the limb, and therefore improve the quality of life
of these patients.
ePO5-414 GOUT, A RARE CAUSE OF THE PAINFUL HIP ARTHROPLASTY
Afinowi R, Afinowi R, Taggart T, Hahnel J
Bradford Royal Infirmary, Bradford Teaching Hospitals NHS Foundation Trust, Bradford,
UK
Introduction: Symptomatic gout in a painful hip arthroplasty is an
extremely rare phenomenon which poses a diagnostic challenge.
Case: A 72 year old male developed pain 18 months after uncemented total hip
replacements. He had gout for 20 years and noticed the onset of pain in his hip
following acute gout in his hallux. Isotope bone scan was normal and serum
inflammatory markers including CRP were also normal. CT scanning revealed an
irregular periprosthetic lucency with sclerotic rim around the periphery of the
acetabular cup consistent with osteolysis but otherwise no evidence of implant
loosening or malposition. There was a prominent anterior acetabular osteophyte and
dynamic ultrasound suggested impingement of the iliopsoas tendon.
Following a failure of resolution of symptoms, his hip was explored and a subgluteal
abscess-like collection was found. Microbiological culture including extended and
atypical organisms (mycobacteria, yeast and fungi) were negative. The patients'
symptoms resolved postoperatively without specific management but recurred several
months later when an MRI scan showed a recurrent irregular thick-walled 5 × 5 cm
anterior collection communicating with the joint. Cultures from aspiration remained
negative. Microscopy was performed for monosodium urate crystals. Blood urate was
332 (266-474). Symptoms improved again after aspiration and management of his gout
is being optimised.
Discussion: There have previously been only two cases reported of gout
in a prosthetic hip. This case demonstrates the difficulty in diagnosis.
Investigations aimed initially at diagnosing infection ultimately led to the rare
diagnosis, which should be considered in the painful hip replacement in the absence
of other causes.
ePO5-451 INTRAOPERATIVE FEMORAL FRACTURES DURING CEMENTLESS TOTAL HIP
ARTHROPLASTY
Miura Y
Funabashi Orthopaedic Hospital, Funabashi, Chiba, Japan
Introduction/objectives: The total numbers of cementless total hip
arthroplasty (THA) are increasing. Intraoperative periprosthetic fractures are
becoming serious problem according to the increased use of cementless fixation. The
purpose of this study is to review the results of cerclage wiring applied to
intraoperative femoral fractures.
Methods: Of 4921 joints of cementless THAs in our hospital between 2004
and 2015, 205 joints had intraoperative femoral fractures. Primary THAs were 201
joints and 20 joints were revision THAs. All procedures were performed by direct
anterior approach (DAA). The average follow-up periods were 4.7 years. We
investigated the rate of fracture, the risk factors of fracture and survival rate of
implant.
Results: We performed intraoperative cerclage wiring for 199 joints. The
risk factors of intraoperative femoral fractures were female, severe dysplastic hip,
and revision surgery. All fractures have achieved bony unions except one stem with
sinking over 5 mm.
Conclusions: The cerclage wiring for intraoperative fractures of
cementless THAs could achieve excellent results.
ePO5-342 ADVERSE REACTIONS TO METAL DEBRIS IN DUROM HIP RESURFACING -
PSEUDOTUMOR INCIDENCE AND METAL ION CONCENTRATIONS
1University Center of Orthopaedics and Traumatology, University Medicine
Carl Gustav Carus Dresden, Dresden, Germany; 2University Center of
Orthopaedics and Traumatology, University Bonn, Bonn, Germany
Introduction/objectives: Goal of this study was to evaluate the
incidence of Adverse Reactions to Metal Debris (ARMD) in a consecutive series of
DUROM Hip Resurfacing Arthroplasty (HRA) at midterm follow up.
Methods: Between October 2003 and March 2007 a total of 135 consecutive
Durom HRA in 122 patients were performed at our institution. Followup could be
obtained in 102 unrevised patients (83%) at a mean time of 8.51 ± 0.97 years
postoperatively and included patient related outcome measurement, plain radiographs,
MARS-MRI as well as whole blood metal ion assessment.
Results: Seventeen (16.3%) out of 102 hips revealed pseudotumour
occurrence in MRI investigation, ten (9.6%) with a diameter of more than 2 cm.
Higher incidence of pseudotumours was found in females, patients with femoral
component size <50 mm and cup inclination >55°. 38 patients had elevated
cobalt levels, 36 of them (35%) in the interval of 2-7 microgram/l and 2 patients
(1.9%) with an elevation of >7 microgramg/l. In contrast to cobalt determination
only elevated chrome values showed a positive association with pseudotumour
occurrence and size.
Conclusions: There is a significant proportion of patients who developed
pseudotumours and metal ion elevation in a consecutive cohort of DUROM HRA after
midterm follow-up. The incidence however seems not to differ substantially from the
results of other well performing resurfacing brands and the clinical relevance of
our findings is still unclear. Regarding the potential local as well as systemic
effects of metal particle release, close follow-up of patients even with clinically
well- performing implants is essential.
ePO5-152 TOTAL HIP ARTHROPLASTY WITH APPLICATION OF SINGLE-CRYSTAL CORUNDUM IN
THE FRICTION PAIR
Filipenko V, Bondarenko S, Tankut O, Mezentsev V,
Marushchak O, Hetman A
Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
Introduction/objectives: The main cause of late aseptic loosening in THA
is the wear of friction pair of prosthesis.
Methods: Between 1998 and 2013 in the department of joint pathology we
performed 28 operations on 25 patients involving total hip arthroplasty with
sapphire-polymeric and sapphire-sapphire pair of friction.
8 patients underwent the implantation of sapphire-polymer in friction pair, whereas
in other 20 cases sapphire-sapphire pair of friction was used. Total hips
replacements in 17 patients were selectively performed with the use of sapphire cups
in cement fixation, and un-cemented fixation in hip replacements were applied in 3
patients (2 patients were treated with the press-fit technique, and 1 patient
required screw fixation).
Results: The average duration of the investigation is 8.3 years (3-17),
the functional results of hip arthroplasty according to the Harris Hip Score
increased from 36 to 84 points. X-ray results show the endoprosthesis stability, no
areas of osteolysis and signs of the wear of friction pair were identified.
Two hip revision surgeries were performed (7.1%). The first revision procedure took
place due to fatigue fracture of the titanium stem of the individual prosthesis and
another one was performed 9 years after the initial operation (Gerchev's stem was
used and cup with sapphire-polymeric pair of friction) due to aseptic loosening of
the endoprosthetic stem for osteoporotic-related reasons. Investigation after
removal friction pair material showed that the wear of sapphire head and polymer
insert inlay was about 0.1 mm.
Conclusions: Total hip arthroplasty with application of single-crystal
corundum in the friction pair gives long-term results. Further research of this
prosthesis implantation is required.
ePO5-309 RESULTS AND COMPLICATIONS OF TOTAL HIP ARTHROPLASTY WITH
CERAMIC-CERAMIC
Garcia P, Leal D, Kimura O, Freitas E, Fernandes
M
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: Total hip arthroplasty (THA) is one of the
great triumphs of modern medicine. New materials have been developed in recent years
to reduce early wear and osteolysis. Ceramics are extremely resistant to scratching
and have excellent biocompatibility, chemical stability and very low coefficient of
friction. The tribological ceramic-ceramic surface has been increasingly used. The
objective of this study is to evaluate the results and complications of total hip
arthroplasty with ceramic-ceramic components.
Methods: The sample consisted of 135 patients with surgeries performed
between 2007 and 2011. Eight were excluded for lack of follow-up and removal of
implants due to infection. Radiographic analysis included the zones of DeLee and
Gruen, the acetabular abduction angle and alignment of the femoral component.
Results: The mean age of patients was 47.1 years comprised 54.3% of men
and 45.7% women. The acetabular inclination of the implant varied between 38° and
56° and the varus femoral implant exceeded 3° in only 10 patients. Good or excellent
results were observed in 97.7% of the sample, using the functional score of Merle
d'Aubigné. No complications such as fracture or grinding components were observed
during the period analysed. Osteolysis or migration of the acetabular component was
not seen in any case. In four cases had lines smaller than 2 mm radiolucency, but
the patient remained asymptomatic. No migration or signs of wear were observed on
any acetabulum.
Conclusions: The results showed similarities between the current
studies, especially regarding the survival of the implant and the presence of creak.
Longer follow-up is needed to clarify the outcomes but the medium term showed good
results, with 100% survival at 82 months.
ePO5-268 THE METASUL METAL-ON-METAL TOTAL HIP ARTHROPLASTY: A MINIMUM 15 YEAR
FOLLOW-UP
Stavropoulos N, Alkhaldi S, Epure L, Zukor D, Huk O,
Antoniou J
Division of Orthopaedic Surgery, McGill University, SMBD-Jewish General Hospital,
Montreal, Canada
Introduction/objectives: The Metasul (Sulzer, Basel, Switzerland)
articular MM interface was a 2nd generation MM THA that was introduced in
the 1980's as a promising interface but in December 2001, the manufacturer recalled
it. We report our long-term results in a cohort of patients who received the Metasul
THA.
Methods: Between July 1997 and October 2000, 85 consecutive THAs (75
patients, 44 males and 31 females) received a Metasul THA with cementless Ti femoral
and porous-coated acetabular component and a 28 mm cobalt/chrome femoral head. The
mean age of patients at time of surgery was 49 (range: 17-65 years). Osteoarthritis
was the most common diagnosis (65%). Average clinical and radiographic follow-up was
16 years.
Results: At a min follow-up of 15 years, the mean Harris Hip Score and
UCLA scores for the surviving THAs were 88.9 and 6.3 respectively. Thirteen THAs
were revised at a mean period of 2.5 years (range: 1 month-12.5 years). Ten of the
thirteen revisions were due to failure of osseointegration of the recalled
acetabular component. Two patients required stem revision for aseptic loosening and
one required irrigation, debridement and liner exchange for early post-op infection.
There were no cases of metallosis, ALTR or trunnionosis. When excluding
contamination from manufacturing defects and infection the survivorship for the
Metasul articular interface in this cohort at a min of 15 years is 96%.
Conclusions: With the exception of the recalled components that were not
related to the articular interface, the Metasul articular interface has performed
extremely well at a minimum follow-up of 15 years in this relatively young and
active patient cohort. We believe that the metallurgy of the Metasul interface and
the exclusive use of 28 mm heads led to the successful survivorship of these
THAs.
ePO5-312 MEDIUM TERM DURABILITY OF THE CLS CEMENTLESS FEMORAL
PROSTHESIS
Garcia P, Lugin D, Kimura O, Freitas E, Fernandes
M
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: The clinical and radiological features can
direct the surgeon to surgical techniques or specific implants in total hip
arthroplasty (THA). Cementless stems in the femur are used primarily in young
patients and studies using the CLS Spotorno femoral stems have demonstrated
good-to-excellent mid-term results. The purpose of this study was to evaluate the
clinical and radiographic outcomes of total hip arthroplasy using the CLS Spotorno
femoral stem in the medium term.
Methods: We performed a longitudinal, prospective, descriptive study.
The sample consisted of all patients who underwent total hip arthroplasty primary
with cementless femoral stem Spotorno, with at least five years of post-operative
follow-up. The main data investigated were Singh and Spotorno indexes and
postoperative functional (Merle d'Aubigné index).
Results: We performed 287 total hip arthroplasties in 267 patients. The
mean age was 49.6 years (20-80). The mean body mass index was 27.8 (16.3 to 42.1).
The main cause was coxarthrosis secondary to osteonecrosis of the femoral head
(38.6%). The most common Singh index was type 5 (60.2%). Mean follow-up was 8.9
years (5.5 to 10.8). Twelve patients (4.1%) required revision. Five (1.7%) patients
had aseptic femoral loosening. The excepting that needed review the implant, 97.5%
of patients achieved good or excellent functional results according to Merle
d'Aubigné score.
Conclusions: We obtained results similar to those described in the
literature in relation to the stem cementless Spotorno, especially in patients with
good femoral bone quality. In follow-up of 8.9 years, we obtained survival of 98.2%
with respect to aseptic loosening. The use of cementless stems in the femur has been
showing good results.
ePO5-216 30-YEARS OF EXPERIENCE WITH THE CEMENTLESS IMPLANTED ALLOCLASSIC
TOTAL HIP ARTHROPLASTY SYSTEM - AN ULTRA-LONG-TERM FOLLOW-UP
Böhler N, Pisecky L, Schauer B
Kepler Universitätsklinikum Linz, Linz, Austria
Introduction/objectives: From 1986 on, our institution has been
implanting the Alloclassic Zweymüller and the SL-total hip arthroplasty system. The
aim was to evaluate the results after 30 years.
Methods: All of the 186 Alloclassic stem systems (Zweymüller hochgezogen
and SL; AlloPro/Sulzer Medica, Winterthur, Switzerland and Centerpulse, Winterthur,
Switzerland), implanted in 179 patients from 1986 to 1987, were included in this
study. The mean age at surgery was 62.76 years (standard-deviation 9.34). Thirty out
of 36 patients being still alive, with a mean follow-up of 29.48 years (SD 0.51)
were contacted by telephone and, if suitable for the patient, evaluated
radiologically and clinically. Our loss-to-follow up is 16.7 percent. The mean age
at follow-up was 83.57 years (SD 6.77).
Results: If the endpoint is the removal of the stem for aseptic
loosening, the overall survival rate is 98.38%. If the endpoint is revision for any
reason, the survival rate is 85.48%. Eleven patients needed an exchange of head and
liner, two of them were operated twice on one hip. The mean time from implantation
until change of head and liner was 21.44 years (SD5.92).
Most of the radiolucent lines and osteolytic zones were found in the proximal
Gruen-zones 1 and 7. Overall satisfaction of our patients with the implanted
Alloclassic stem system was good. Only one patient was not satisfied due to leg
length inequality caused by high congenital hip dysplasia of the contralateral side.
We had one case of implant-fracture, which lead to revision-surgery of the femoral
component.
Conclusions: The evaluated system is very reliable in primary and
secondary THA. In our institution it is the basic implant and first one for younger
colleagues to get in contact with.
ePO5-373 A SHORT STEM WITH METAPHYSEAL FIXATION REVEALS A MORE PHYSIOLOGICAL
STRAIN PATTERN COMPARED TO A STANDARD STEM - AN EXPERIMENTAL STUDY IN CADAVARIC
BONE
Introduction/objectives: The supposed advantage of short stem hip
arthroplasty is a bone preserving strategy and less soft tissue damage. Bone
preserving strategies include a more proximal resection of the femoral neck as well
as a predominantly metaphyseal anchorage inducing a presumed more physiologic load
transfer and thus a reduction of stress- shielding. However, the hypothesized
metaphyseal fixation associated with the aforementioned benefits still needs to be
verified.
Methods: Therefore, the METHA short stem as a short stem with proposed
metaphyseal anchorage and the Bicontact® standard stem were tested
biomechanically in three pairs of cadaveric femora using a MTS while strain gauges
monitored their corresponding strain patterns.
Results: For the METHA stem, the strains in all tested locations
including the region of the calcar (95% of the non- implanted femur) were similar to
conditions of cadaveric bone without implanted stem. The Bicontact stem showed lower
strains in the proximal levels including the region around the calcar (57% of the
non-implanted femur).
Conclusions: As a conclusion, the current study revealed primary
metaphyseal anchorage of the METHA short stem and a metaphyseal-diaphyseal anchorage
of the Bicontact stem.
ePO5-238 CLINICAL RESULTS OF MINIMALLY INVASIVE ANTEROLATERAL THA USING A
SHORT FEMORAL STEM
1Ohkubo Hospital, Tokyo, Japan; 2JCHO Saitama Medical Center,
Saitama, Japan
Introduction/objectives: Short femoral stems became available in Japan
in 2012.
The objective of this study is to evaluate the outcome of THA using short femoral
stem (Taperloc Micropasty) in Japanese patients.
Methods: We retrospectively reviewed all 60 THA between July 2013 and
December 2015 at our institute, and 32 THA (53%) were done with short femoral stems.
A single orthopaedic surgeon performed all THA procedures. The surgical approach was
antero-lateral in the lateral position in all cases. The mean age of patients at the
time of surgery was 66.7 years. The original diseases were 29 osteoarthritis and 3
osteonecrosis.
Results: There was no revision, infection, deep vein thrombosis, nor
dislocation. One patient had femoral fracture during the surgery, we had to switch
the stem to the standard one in this case. The average surgery time was 108 minutes
(range, 80-168 minutes); the average blood loss during surgery was 282 g (range,
95-720 g). The cup we used was Regenerex M2a Taper (ZIMMER BIOMET). Median cup size
was 52 mm (range, 48-60 mm); median stem size was 8 and 9 (range, 4-13). The bearing
surfaces were all ceramic on highly cross-linked polyethylene. Radiological findings
showed stem subsidence (within 5 mm) in 2 patients; one had severe osteoporosis,
while the other had leg length discrepancy.
Conclusions: THA using a short femoral stem has satisfactory clinical
and radiological results in Japanese patients.
ePO5-366 CLINICAL AND RADIOGRAPHIC RESULTS OF SHORT STEMS FOR TOTAL HIP
ARTHROPLASTY AT MIDTERM FOLLOW-UP
Introduction/objectives: Significant results have been described about
short stem reliability, but few evidences are actually available about their
effectiveness at medium and long term. The aim of this study is to evaluate the
clinical and radiographic results of a group of patients treated with short-stemmed
hip prosthesis at medium-term follow up.
Methods: 141 patients, undergone short-stemmed hip replacement, were
retrospectively evaluated. The only absolute exclusion criteria adopted for short
stems implantation were BMI>35 and severe osteoporosis. The population was
composed by 75 males and 66 females with a mean age of 62.4 years (25-84 years),
affected by primary osteoarthritis (OA), post-traumatic OA, avascular necrosis and
dysplasia OA. All patients were operated by the same surgeon using a
posterior/minimally invasive approach and were periodically evaluated by standard
X-Ray and clinical outcomes (HHS, WOMAC, SF-12 and VAS).
Results: The mean follow-up was 35.2 months. All the implants were
radiographically osseointegrated, with a failure rate of 0%. Five complications were
observed (1 dislocation, 2 partial sciatic palsy, 1 eterotopic ossification, 1
intraoperative fracture). A rapid improvement of clinical outcomes including recover
from pain and joint function, were observed (HHS: 92.9; VAS pain: 7.5) with a
significant improvement in the quality of life (SF-12P: 52.1; SF-12M: 56.4; WOMAC:
88.2).
Conclusions: Short stem implants showed good clinical and radiographic
results at medium term follow up. Bone stock saving and excellent load distribution
allows to avoid stress shielding and tight pain, and to perform easier revision
surgery. Short stems in hip replacement represent a good therapeutic choice in the
treatment of primary and secondary hip osteoarthritis.
ePO5-98 RM ACETABULAR CUP: MULTICENTRIC EXPERIENCE IN COLOMBIA
Restrepo N1, Arbelaez W2,
Martinez C3
1Clinica de Reemplazos Articulares, Pasto, Colombia; 2Hospital
Militar Central, Clinica Saludcoop, Bogota, Colombia; 3Epsiclinicas
Saludcoop, Bogotá, Colombia
Introduction/objectives: Good long-term results in an acetabular cup
depend on good osseointegration. The Vitamys RM cup has recently arrived to
Colombia, a cementless, titanium coated monoblock cup with a vitamin stabilized
highly cross-linked poly, which shows excellent long-term results in Europe. We
decided to begin our implantation in Colombia doing a prospective multicentric
study.
Methods: A prospective protocol for three independent hip arthroplasty
surgeons, was designed to evaluate position, press fit, clinical and radiological
osseointegration in the first 85 hips implanted in Colombia; clinical and
radiological follow-up's were performed immediately, 6 week and 6 months after
surgery, using the De Lee & Charnley 3 zone classification, looking for
sclerotic or lucent lines.
Results: We evaluated the first 85 cases who underwent a Total Hip
Arthroplasty, 26 (31%) males, 59 (69%) females, with ages ranging from 27 to 80
years, (average 55), using Vitamys press fit monoblock cup 31(36%) 28 head diameter,
11 (13%) 36 head and 43 (51%) 32 head size, without using screws in 72 (85%). In all
85 cups, 6 months x-rays showed complete osseointegration.
Conclusions: At the moment good results with the Vitamys RM Cup from
Mathys in Europe, seem to be reproducible in our country, obtaining excellent
fixation with good osseointegration in our 85 first RM hips in Colombia.
ePO5-375 THE POSTOPERATIVE REDUCTION IN BONE DENSITY AROUND THE CEMENT - LESS
ACETABULAR CUP IN PRIMARY THA
Mizushima M, Ichikawa R, Yonemori K
Yonemori Hospital, Kagoshima, Japan
Introduction/objectives: Trabecular Titanium is characterized by a high
open porosity that imitates the morphology of trabecular bone. The surface roughness
of the component is considerably greater than that of earlier designs, which
theoretically may contribute to more stable initial fixation.
The primary objective of this study is to evaluate the BMD around a cementless
acetabular cup made of Trabecular Titanium in primary total hip arthroplasty by
means of DEXA.
Methods: We checked over 35 hips underwent primary THA by one surgeon
with cement-less highly porous cups made of Trabecular Titanium. There were 5 men
and 30 women, with a median age (66.8 years) and BMI (22.3 Kg/m2). Diagnoses were
primary OA in 10 (28.6%) cases, RA in 1 (2.9%) case, SLE in 1 (2.9%) case, and DDH
in 23 (65.7%) cases. 29 cups were fixed with 2 screws and 6 hips were fixed with
only a press-fit technique. BMD was determined by DEXA according to DeLee and
Charnley 3 ROIs at 2 weeks, 6, 12 months after the surgeries. Statistical analyses
were carried out by using non-parametric tests (Mann-Whitney) and a P<0.05 as
threshold for statistical significance.
Results: BMD values initially declined from baseline at 2 weeks to 6
months (median ROI1: 87.9%; ROI2: 97.4%; ROI3: 98.5%) and to 12 months (median ROI1:
85.2%; ROI2: 95.1%; ROI3: 99.0%). There was a statistical significant decrease in
ROI1 from baseline to 6 months (P = 0.002) and to 12 months (P = 0.0004). BMD in DDH
cases was decreased more than BMD in primary OA cases for the first 6 months.
Conclusions: Our evaluations of BMD confirmed the insufficient
periacetabular osseointegration in ROI1 for the first 12 months. And DDH may be
suggested of the cause of the initial migration of the cup.
ePO5-99 CORRECTING THE HIGH HIP CENTER IN HARTOFILAKIDIS, LOW DISLOCATION OR
CROWE II DISLOCATED HIPS: SURGICAL TECHNIQUE AND MID-TERM FOLLOW-UP
Restrepo N
Clinica de Reemplazos Articulares, Pasto, Colombia
Introduction/objectives: Crowe II dislocated hips are probably the most
difficult acetabulum to perform, because usually there is a complete absence of the
superior wall, a bad anterior wall and in general a shallow acetabulum. This paper
shows a reproducible technique to work the real acetabulum obtaining an ideal
rotational center of the hip.
Methods: This prospective study shows a simple surgical technique in
Crowe II dislocated hips, resecting bone according to the acetabular fossa position,
to place a cup in the ideal center of rotation, along 3 to 10.5 years (mean 7.2
years) and shows the clinical outcome in 64 hips.
Technique:
Complete capsulectomy.
Looking for the transverse ligament and acetabular fossa.
Palpate and evaluate posterior and anterior walls.
Resect a bone 2.5 cm square leaving the acetabular fossa as our center.
Begin to ream, first with medicalization.
Results: We perform a Total hip uncemented arthroplasty in 64
chronically dislocated Crowe II hips, trying to get the ideal center of rotation,
according to the T.A.R. True acetabular region, and less than 35 millimeters up to
the inter-drop line, obtaining our target in 100% of our hips, without related
complications with our technique (acetabular fractures, disruptions or early
loosening).
Conclusions: Low dislocation in chronic dislocated hips probably is the
most difficult acetabulum to perform, and frequently is finished with a high hip
center, without correcting length discrepancy and gait. This reproducible technique
allows us to put our acetabular component in the best position as we can prove in 64
hips.
ePO5-201 TOTAL HIP ARTHROPLASTY AFTER COMPLEX ACETABULAR FRACTURES. A
COMPARATIVE AND PROSPECTIVE STUDY
Sirianni R1, Garcia-Rey E2,
Garcia-Cimbrelo E2
1Hospital Universitario La Paz, Hospital Traumatologia - Cirugia
Ortopedica y Traumatologia, Madrid, Spain; 2Hospital La Paz, Madrid,
Spain
Introduction/objectives: In our series we compare clinical and
radiographic results of two groups of patients who underwent THA after a complex
acetabular fracture.
Methods: We analysed the results of 73 THAs comparing two groups. Group
1: patients initially treated conservatively and then treated with THA associated
with acetabular reconstruction (43 hips). Group 2: patients who underwent THA after
a failed osteosynthesis (30 hips). The mean delay between fracture and THA was
62.5+5 months in group 1 and 57.9+5 in group 2. The mean follow-up was 12.3 years.
Bone defect according to Paprosky et al. was greater in group 2 (p = 0.001). We used
more frequently autologus bone graft of the femoral head in group 1 (p = 0.002). We
assessed the cup position and the reconstruction of the rotation centre of the
hip.
Results: There were 3 cup revisions for aseptic loosening in each group.
The survivorship analysis at 15 years was 94.1% in group 1 and 90.0% in group 2. Six
sciatic palsies developed after trauma and 2 after osteosynthesis. There were no
infections. Clinical results were better regarding mobility in group 1 than in group
2 (p = 0.029). The distance between the femoral head and the rotation centre of the
hip was better in the group 2 (p = 0.006).
Conclusions: Long-term clinical and radiograph results are good in
patients who underwent THA after a complex acetabular fracture. A primary THA
associated with acetabular reconstruction had better clinical results regarding
mobility and better radiographic acetabular reconstruction. Nevertheless,
ostheosynthesis is the treatment of choice for simple displaced acetabular
fractures.
ePO6 Paediatrics, Infection
eP06-59 EVALUATION OF THE LOADS APPLIED ON THE HIP JOINTS IN WALKING WITH AND
WITHOUT SCOTTISH RITE ORTHOSIS IN SUBJECTS WITH PERTHES DISEASE
Karimi M
Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
Introduction/objectives: Although the main aims of treatment in
Legg-Calve Perthes disease are to increase the containment of femoral head within
the acetabulum, and to decrease the loads applied to the hip joint, none of the
treatment approaches were successful. There was no research evaluate the effect of
using orthosis on joint reaction forces in subjects with Perthes disease. Therefore
the aim of this study was to evaluate the joint reaction force in subject with this
disease while walking with and without orthosis.
Methods: Two subjects with Perthes disease participated in this study.
They were asked to walk with and without Scottish rite orthosis. Open SIMM software
was used to extract the joint reaction forces in both conditions. The difference
between kinetic and kinematic parameters for each subject was evaluated by two
sample t test.
Results: The results of this study showed that the ground reaction force
applied on the leg increased while walking with orthosis, however joint reaction
forces seems to decrease follow the use of the orthosis. Use of orthosis influences
the kinematic of hip joint and pelvic.
Conclusions: Sine joint reaction force is one of the main parameters
influence hip joint deformation, use of orthosis may influence the final
deformation. It is recommended to do a research with a higher number of
subjects.
ePO6-50 PROPHYLACTIC PINNING IN EPIPHYSIOLISYS CAPITIS FEMORIS
Holiuk Y, Filipchuk V, Kabatsii M
Institute of Traumatology and Orthopaedics AMS of Ukraine, Kyiv, Ukraine
Introduction/objectives: There is no single approach for prophylactic
pinning in unilateral epiphysiolisys capitis femoris. It was the basis for
developing differentiated approach for the procedure which would consider the
skeletal maturity of the hip and the period of sexual development for determination
of indications to perform the procedure.
Methods: The whole group of study consisted of 249 patients. We used
method for determining skeletal maturity by radiographs of hips by analysing 250
radiographs of 107 patients with radiographic signs of hip pathology and without
that. The basis for its development was the Oxford method. To develop a
differentiated approach we used hip radiographs and endocrinological study of 50
patients with epiphysiolisys capitis femoris and 50 patients without radiographic
signs of pathology. To assess the results of prophylactic pinning we used hip
radiographs of 92 patients with unilateral epiphysiolisys capitis femoris which did
not apply a differentiated approach and 50 patients who were applied it.
Results: Prophylactic pinning is indicated for patients of prepuberty
and induction of puberty (till 41 points of skeletal maturity). On the model of
“finite elements” we have found that eccentric screw location with prophylactic
pinning leads to destruction of the cartilage of epiphyseal growth plate, so the
location of the screw in the centre of growth plate is the perfect position and
deviation from the axis for 2 mm is acceptable. We found that the growth of the
femoral neck of patients of prepuberty and induction of puberty was being continued,
despite the prophylactic pinning. Neck growth of patients of puberty was not
observed.
Conclusions: Differentiated approach to prophylactic pinning lets 50%
decrease indications for its implementation and ensure lack of slip on the
contralateral hip in 100% of patients with unilateral epiphysiolisys capitis
femoris. Sensitivity of method consists 93.75%, specificity – 100%.
ePO6-51 THE ROLE OF EPIPHYSEAL REMODELING FOR TREATMENT OF EPIPHYSIOLISYS
CAPITIS FEMORIS
Holiuk Y, Filipchuk V
Institute of Traumatology and Orthopaedics AMS of Ukraine, Kyiv, Ukraine
Introduction/objectives: Monitoring of epiphyseal remodelling of the
epiphysiolisys capitis femoris is difficult, but it is important for the prognosis
and determining tactics of its treatment. We have developed tactics of surgical
treatment epiphysiolisys capitis femoris depending on the epiphyseal
remodelling.
Methods: The study includes analysis of the radiographs of 132 patients.
To assess remodelling, we proposed angle which is determined on the lateral
radiograph of the hip and it was formed with upper and lower edge of the femoral
head and the top edge of the femoral neck. We also determined the skeletal maturity
of the hip and stage of sexual development of patients.
Results: We established that angle referent for assessment of
performance is in the range from 0° to 3° (p<0.01). Period of monitoring
epiphyseal remodelling ranged from 4 to 24 months. We recommend the tactic of
surgical treatment of epiphysiolisys capitis femoris: for the 1st degree of
displacement in the prepuberty we recommend pinning, for patients of puberty -
combination of pinning and osteochondroplasty. For the second degree of chronic
displacement we recommend flexion intertrochanteric osteotomy, and for the second
degree of acute displacement and 3rd degree - neck osteotomy.
Conclusions: Prediction of epiphyseal remodelling of the epiphysiolisys
capitis femoris improves functional result of surgical treatment from 30% to 50%
depending on the degree of displacement of the femoral head and the type of
displacement, if we ignore the process further leads to additional surgery in these
patients.
ePO6-339 OUTCOMES OF SINGLE-STAGE OPEN REDUCTION, SALTER INNOMINATE OSTEOTOMY,
AND PROXIMAL FEMORAL OSTEOTOMY FOR THE MANAGEMENT OF DEVELOPMENTAL DYSPLASIA OF
THE HIP IN CHILDREN AGED FROM 1 TO 10 YEARS
Pozdnikin I, Baskov V, Barsukov D, Bortulev
P
Turner Institute for Children's Orthopaedics, Saint Petersburg, Russian
Federation
Introduction/objectives: Hip open reduction, innominate osteotomy and
proximal femoral osteotomy in cases of late diagnosed developmental dislocation of
the hip (DDH) are widely used now.
Assessment of long-term results of one-stage surgical treatment of patients with late
diagnosed DDH and detection of main risk factors for adverse outcomes of
treatment.
Methods: We retrospectively reviewed the cases of 65 patients who had 87
single-stage open reduction, Salter innominate osteotomy, and proximal femoral
osteotomy between 1978 and 2006. At the time of the operation, the mean age of the
patients was 3.9 years (range 1.0-10.1 years).
Results: The average time of follow-up was 16.2 years (range: 10-37
years). A total of 70.4% of good or excellent outcomes were obtained for clinical
functional evaluation according to the McKay classification. For radiographic
outcomes, 67 hips (75.9%) were classified as good or excellent according to the
Severin classification. A total of 29.3% of all hips had a poor outcome according to
the Kalamchi and MacEwen classification for AVN. The poorest outcomes were observed
for clinical, radiographic and AVN results in children with: teratologic dislocation
of the hip, previously performed long conservative treatment, multiple attempts of
closed reduction with the development of AVN, age over 8 years old at the time of
surgery (p<0.05).
Conclusions: One-stage treatment is a good selection for late-diagnosed
DDH. Best results can be obtained in children in the age group of 1.5-5 years old
with typical DDH non associated with other congenital malformations and without
signs of AVN at the time of surgery.
ePO6-260 LONG-TERM RESULTS OF POSTERIOR FEMORAL ROTATIONAL OSTEOTOMY IN
CHILDREN WITH DDH
Sakalouski A
Republican Centre for Traumatology and Orthopaedics, Minsk, Belarus
Introduction/objectives: Multiplane deformity of the femoral head in
children with DDH is a serious problem.
Methods: We used our own technique of intertrochanteric osteotomy with
posterior 45-90° rotation of the proximal part of the femur in the 52 cases (50
patients) in children (aged from 3 to 18 years). The aims of the operation were:
elimination of load on a deformed superior segment of the femoral head, restoration
of the femoral head centralization and articular surface congruity, normalization of
the greater trochanter position, lengthening of the femoral neck.
Results: The results were studied with the mean follow-up of 8.1 years
(5-25 years) after the operation. The mean value of the epiphyseal quotient
increased to 81 against 53 and the epiphyseal-neck quotient - to 87 against 61
before the intervention, the neck-diaphyseal angle became 130° after the operation.
Before the operation Wiberg angle was equal to 20-25° only in 10 cases, after – it
became 20-40°(average 30°) in 41 cases. In case when Wiberg angle was less than 20°
rotational osteotomy was complemented by the operation on the pelvis (5 triple
pelvic osteotomies, 3 Salter osteotomies, 2 Chiary osteotomies, 1 acetabular
plasty). According to Severin system (modified by Ziots) the radiological results
were as follows: 13 joints are referred to group I, 28 - to group II, 7 - to group
III and 4 - to groups IV-V. The clinical results were assessed according to McKay's
system, modified by Zionts, good and excellent results were registered in 46 cases
(88%).
Conclusions: The merits of the intervention are: reorientation of the
femoral head in three dimensions, absence of angle deformities and negative
influence on the growth plate of the femoral head, lengthening of the femoral neck
and limb.
ePO6-456 SURVIVAL RATE OF HIP RESURFACING IN A LOW VOLUME CENTER: 9 YEARS
FOLLOW-UP
1University Hospital Infanta Leonor, Madrid, Spain; 2University
Hospital Principe de Asturias, Alcalá de Henares, Madrid, Spain; 3Tan
Tock Seng Hospital, Singapore, Singapore; 4University Hospital Miguel
Servet, Zaragoza, Spain
Introduction/objectives: Hip resurfacing in young patient was a common
practice a few years ago. Low volume centres has been mentioned as a risk factor for
failure of hip resurfacing. The purpose of our study was to determinate the survival
rate and complications after hip resurfacing in a low volume centre.
Methods: We present a study of a cohort of 46 consecutive patients
younger than 55 y.o. treated with a hybrid metal-on- metal total hip resurfacing
(BHR). Mean follow up was 9.23 years (minimum follow-up of 8 years). We evaluated
radiolucencies and implant mobilization. Merle-D'Aubigne-Postel hip score and WOMAC
questionnaire pre-operatively and at last follow-up. SPSS 13.0 software was used for
statistical data analysis. Chi square and non-parametric tests were used.
Results: Mean age was 48.1 years. Patients were mostly male (41
cases-89.1%). Surgery was performed for 4 different Orthopaedic Surgeons (3 of them
with less than 15 hip resurfacing cases a year). All patients improved the WOMAC,
SF36 scores (p<0.05). Merle D'Aubigne score improved from 9.6 to 17.2
(p<0.05). More than 70% of the patients resume to their previous sport activities
but only 60% of the patients went back to their previous work. No radiological
radiolucencies or implant displacement were detected. Three cases have to be revised
due to neck collapse and implant mobilization at mean 3.4 years after implantation.
One case required a new surgery due to psoas tendinitis. One has been revised for
dislocation. At 9.23 years, our survival rate with need of surgery for any cause,
was 89.13%.
Conclusions: Long term follow up of hip resurfacing replacement showed
acceptable survival rate (89.13% at 9.23 years) despite were performed by different
surgeons in a low volume centre.
ePO6-376 7-YEAR RESULTS OF TOTAL HIP ARTHROPLASTY WITH THE UNCEMENTED AVENIR
STEM
1Chu Gabriel Montpied, Service Chirurgie Orthopédique, Clermont Ferrand
Cedex 1, France; 2Polyclinique de Franche Comté, Service Chirugie
Orthopédique, Besançon, France
Introduction/objectives: Based on the well-regarded and proven fully
hydroxyapatite (HA) coated stems utilizing a bone compaction technique, the Avenir
Stem was released in 2005. The objective of this clinical data review was to examine
the 7-year results of the fully HA coated Avenir Stem. We hypothesized that the
subject stem will achieve similar favourable outcomes as the originally fully HA
coated bone compaction stems that are in the market.
Methods: In this prospective study, 100 consecutive primary hips in 92
patients with mean age at surgery of 58.5 ± 10.7 years were enrolled at two centres
between January 2006 and October 2008. Mini-incision (50%) and standard approaches
(50%) were used to implant 22 standard and 78 lateralized stems. Harris hip score
(HHS) and radiographic outcomes were evaluated. Kaplan-Meier (K-M) survivorship
analyses were performed with the end point of stem revision for any reason.
Results: At the time of this review (mean follow-up of 84.2 ± 10
months), no stem related complications occurred. The one stem revision was due to
deep infection at 4 years postop. The stem K-M survivorship was 99.0% at 7 years.
For the 86 hips available at the 7-year follow-up, mean HHS was 93.1 points (range,
60-100). The radiographic analysis showed two patients had non-progressive
radiolucent lines and no patient had any signs of stem subsidence or loosening.
Conclusions: This is the first study on the Avenir Stem. The study
showed excellent mid-term clinical results in hip arthroplasties performed with this
HA coated stem, with no stem revisions due to aseptic loosening. This study will
continue to corroborate 10-year data.
ePO6-249 INFECTION OF REVISION HIP PROSTHESIS BY GRANULICATELLA
ADIACENS WITH ABDOMINAL ABSCESS FORMATION
Fraile Suari A, Puig Verdié L, Marqués López F, Tey
Pons M, Alier Fabrego A, Cuenca Llavall M, Lizano Diez J, León García A
Hospital del Mar i l'Esperança, Barcelona, Spain
Case study: Granulicatella or
Abiotrophia is a slow growth gram positive
Streptococcus, normal flora of the oral cavity, which rarely
produce osteoarticular infections.
We describe a case of a 43 years old man who had been wearing a revision hip
prosthesis since 2003 because of an aseptic loosening. Consults in 2007 for
complaining about hip pain, fever and tachycardia. The study performed with
intraarticular puncture showed positive cultures for multisusceptible
Abiotrophia sp, but he refused the treatment. In 2014 he came
with a 3 months evolution abdominal tumour, fever and mild hip pain. The blood
analysis test showed a C-reactive protein of 1.6 mg/dl without leukocytosis and in
the CT-scan we could observe a 8.5 × 2.5 cm mass in the abdominal wall in continuity
with the hip prosthesis. Then, a first step exchange with implantation of a hip
spacer and debridement of the abdominal abscess was performed. The cultures were
positive for Granulicatella adiacens and we decided to start a 9
week treatment of endovenous G-Penicillin and oral Amoxicillin. Finally, a
definitive hip prosthesis was implanted.
The follow-up was clinically and radiologically satisfactory. The cultures of the
second surgery were all negative and 8 months later the patient remains asymptomatic
and walks without difficulties.
Granulicatella is a slow growth microorganism, nutritional variant
of Streptococcus, which requires Pyridoxine or other additional agents to grow in
usual culture preparations. It responds adequately with G-Penicillin and Amoxicillin
and must be suspected in cases of slow alpha-haemolytic
Streptococcus growing without significant alteration of the
acute phase reactants. In the literature there are very few cases of osteoarticular
infection by this microorganism.
ePO6-46 REFRACTORY PERIPROSTHETIC HIP ARTHROPLASTY INFECTION, RISK FACTOR
EVALUATION AND TREATMENT WITH DIRECT LOCAL ANTIBIOTIC INJECTION, AN EXPERIMENTAL
STUDY
Savadkoohi D, Siavashi B, Pendar E, Aalirezaei
A
Tehran University of Medical Sciences, Sina Hospital, Tehran, Islamic Republic of
Iran
Introduction/objectives: In some cases of periprosthetic joint
infection, despite debridement and prosthesis removal and insertion of antibiotic
impregnated cement spacer, infection does not resolves in the first stage. In this
study, we try to eradicate infection in these refractory cases with local injection
of antibiotics.
Methods: It is a prospective study. Every cases with late periprosthetic
hip arthroplasty infection candidate for two stage treatment of PJI entered study.
If in first stage infection cannot be eradicated, after complete debridement and
implant removal a large drain pipe was inserted deep in the wound. Intravenous
antibiotics were started in usual manner but extra antibiotics were injected through
drain directly in the depth of wound. If infection had been resolved, the second
stage (re implantation) was done.
Results: From 2005 to 2014, 2446 hip arthroplasties had been performed
in our Hospital. Infected cases were studied. There were 46 cases of infection
considered to be appropriate for two stage total hip arthroplasty. There were 14
cases (30%) which were refractory to first stage of treatment. Previous hip
operation, obvious discharge, sinus tract, earlier appearance of infection are signs
that PJI is refractory to ordinary first stage of treatment.
Conclusions: It seems if a periprosthetic hip joint infection presents
earlier with more aggressive signs and in a previously operated hip, especially in
diabetic patient and with gram negative organism, it may be better to start first
stage of treatment with this new method.
EPO6-105 TWO-STAGE REVISION TREATMENT FOR STAPHYLOCOCCAL PROSTHETIC HIP JOINT
INFECTION
Demyanchuk A, Grigoricheva L, Karbysheva S, Syukov I, Kozhevnikov
V
Federal Center of Traumatology, Orthopaedics and Arthroplasty, Barnaul, Russian
Federation
Introduction/objectives: Optimal treatment for prosthetic joint
infection (PJI) after hip arthroplasty remains controversial. The prevalence of
infection is reported between 1% and 4%. Recently reported high success rates,
however, were not stratified on the basis of the type of organism. Purpose of the
study was to review results in our patients who had two- stage reimplantation for
the treatment of staphylococcal PJI at the site of the total hip replacement.
Methods: We have prospectively followed up 26 patients treated for
staphylococcal hip infection (≥2 positive specimens on pre-operative aspirate and/or
intraoperative cultures) between January 2014 and December 2015. Ten patients were
excluded because of using one-stage or incomplete two-stage procedure. There were 16
patients in the group. The causative organisms were MSSA in 6, MSSE in 5, MRSE in 5
patients. Every patient received two-stage reimplantation using the articulated
space followed by systemic antibiotic therapy. Minimum follow-up was 2 months after
the second stage (mean, 11.7 months; range, 2-22 months). None of the patients was
lost to follow up.
Results: All of the patients were questioned about any sign of infection
relapse including high body temperature, any persisting wound drainage, fistula
formation, and worsening of the pain. At the time of last follow up, there was 1
patient who has had relapse of infection. Efficacy of the treatment method was
94%.
Conclusions: There are some limitations in our study. It is a small
series of patients, which therefore makes it difficult to draw definitive
conclusions regarding the influence of treatment. In addition, because of the
growing concern regarding the MRS infection, we will continue our study stratifying
results on the basis of causative organism.
ePO6-420 TWO-STAGED REVISION HIP ARTHROPLASTY FOLLOWING SEVERE CHRONIC
INFECTION ASSOCIATED WITH TOTAL HIP REPLACEMENT - AN INDIVIDUAL APPROACH
Tzachev N, Stoichkov V, Ivanov N
Military Medical Academy, Sofia, Bulgaria
Introduction/objectives: Although not very common (0.5 to 3%) infection
occurring after total hip replacement is a devastating complication. Two-staged
revision arthroplasty has become the golden standard for treatment of hip
periprosthetic infections. In this study we present our clinical experience with
treatment of severe hip periprosthetic infections using premoulded Gentamycin
impregnated hip spacers at the first stage and cementless hip systems at the second
stage. Our objective was to develop an individual approach for treatment of severe
hip periprosthetic infections using two-staged revision arthroplasty.
Methods: For a period of 4 years (2011-2015) 34 patients were operated
because of severe chronic infection associated with total hip replacement at our
clinic. In all cases active sinus, septic implant loosening and periprosthetic bone
loss were observed. Manifestation of the infection was more than six months prior to
admission at our department (average 8.1 months). 15 patients had undergone
non-radical surgical debridement procedures prior to their admission at our
department. Two-staged revision hip arthroplasty was performed in all cases,
although second stage was performed after an elongated time period (average 8.9
months) Results: In 29 cases (85.3%) infection was eradicated and in a
one year follow-up we didn't observe relapse of the infection in this group of
patients. In 5 cases relapse of the infection was observed - in 2 cases (14.6%)
during the first month after the second stage and in 3 cases between the third and
the sixth month.
Conclusions: In such complicated cases of severe chronic periprosthetic
infection it is crucial to schedule the second stage after a longer, individually
calculated period based on numerous different factors.
ePOSTERS WITHOUT PRESENTATION
eP1 ePosters without Presaentation
eP1-354 PERIOPERATIVE PAIN MANAGEMENT IN HIP ARTHROSCOPY, WHAT OPTIONS ARE
THERE?
1Slotervaart Center of Orthopaedic Research and Education, MC Slotervaart,
Amsterdam, The Netherlands; 2MC Slotervaart, Department of
Anaesthesiology, Amsterdam, The Netherlands
Introduction/objectives: Hip arthroscopy is a fast growing orthopaedic
field of expertise. As in any field of surgery adequate postoperative pain
management regimes are of utmost importance. The purpose of this review is to
provide an overview of current knowledge on aesthetic options for perioperative pain
management for hip arthroscopy.
Methods: We searched the Pubmed/Medline and Embase database for
literature and included 10 studies for our analysis. Because of the variety of pain
scales and different ways of measured pain no meta-analysis could be performed and a
descriptive review is performed.
Results: There are several types of pain regimens that can mostly be
divided in two groups: local anaesthetics and nerve blocks. Included studies shows a
rather large variation in reported VAS scores, PACU admission time and opioid
usage.
Conclusions: There are several aesthetic options available for hip
arthroscopy. Different studies use different dosages, aesthetic regimens and
different protocols; this partly explains the differences between studies with
similar techniques. Peripheral nerve blocks seems promising but regarding current
literature no clear recommendation can be made about what the best perioperative
pain management option is, an overview of all reported techniques is given.
eP1-372 THE SINGLE BACK MATTRESS LABRUM SUTURE TECHNIQUE FOR ANATOMICAL LABRUM
REFIXATION AND POSITIONING
Gebhart C1, Casari F2, Felsing
C3
1Privatklinik Döbling, Vienna, Austria; 2PMU Salzburg,
Salzburg, Austria; 3Univ. Klinikum St Pölten, St. Pölten, Austria
Introduction/objectives: Purpose of our study was to develop and
describe the principles, surgical steps and advantages of the anatomical single back
matress labrum suture (SBMLS). For this we reviewed the literature on labrum
acetabular and existing repair techniques. Recent literature has high-lighted the
need for anatomical labrum repair in the hip. We reviewed the literature on labrum
anatomy, biomechanics and refixation techniques and developed a technique that
delivers acetabular labrum base positioning, inversion and eversion with minimal
trauma.
Methods: The Single Back Mattress Labrum Suture technique (SBMLS) can be
performed with a standard two portal arthroscopic hip access. A thread is fixed with
the SDMLS technique via an arthroscopic piercing instrument on the torn labrum,
which can be anatomically correctly positioned by anchoring at the desired location
in the correct angle and rotation of the soft tissue. This can be achieved by simply
adjusting traction on the different ends of the thread after the SBMLS has been
correctly performed on the area of the labral rupture.
Results: SBMLS supports optimal healing, ingrowth and function of the
refixed labrum at its original anatomic state by providing a very stable functional
refixation. The surgeon gains more freedom for the angle, rotation and positioning
of the labrum.
Conclusions: The SBMLS is an easy option for the surgeon to optimize
his/her surgical result by inverting or everting the labrum to the optimal
anatomical refixation. It provides a new possibility that is not present on the
standard labrum surrounding technique.
eP1-454 IMPRESSION OF SOME INDEX ON OCCURRENCE OF AVN OF FEMORAL HEAD IN SLE
PATIENTS
Badrzadeh F1, Aghaei M2,
Abdollahi N2, Amoli SZ1
1Golestan University of Medical Science, Gorgan, Golestan, Iran;
2Boneand Connective Tissue Research Center (JBCRC), Golestan
University of Medical Science, Gorgan, Golestan, Iran
Introduction/objectives: To study the predictive factors for developing
AVN of femoral head, in patients with SLE.
Methods: 90 SLE patients randomly chosen to be checked for incidence of
AVN of femoral head and the influence of some risk factors such as disease duration,
corticosteroid use, lupus nephritis and level of anti nuclear antibody (ANA).
Results: 7 out of 90 (7.7%) have been suffering from AVN of femoral head
after at least 8 years of struggling from lupus. All of them have had lupus
nephritis and were treated by high dose of prednisolone before developing AVN.
Conclusions: High dose of corticosteroids remains as the main
contributing factor for AVN in SLE. Amount of corticosteroid should be reduced as
soon as possible in case of well-handled disease.
eP1-85 BILATERAL TOTAL HIP ARTHROPLASTY IN FEMORAL HEAD AVASCULAR NECROSIS:
FUNCTIONAL OUTCOMES AND COMPLICATIONS
Taheriazam A1, Saeidinia A2,
Safdari F3
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Guilan University of Medical Sciences, Rasht, Islamic
Republic of Iran; 3Bone, Joint and Related Tissues Research Center,
Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
Introduction/objectives: Total hip arthroplasty (THA) is one of the
successful and cost-benefit surgical treatments. One- stage bilateral THA (BTHA)
offers many benefits. However, there are concerns about the safety of the procedure
and higher complications. We aimed to evaluate the complications and outcomes of
one-stage BTHA with Hardinge approach for femoral head avascular necrosis
patients.
Methods: A total of 60 patients from April 2009 and May 2013, were
underwent one-stage bilateral total hip arthroplasty (BTHA) in Milad and Erfan
hospitals, Tehran, Iran. A prospective analysis of the functional outcomes and
complications of one-stage BTHA through Hardinge approach in patients with femoral
head avascular necrosis (AVN) performed. We evaluated all patients clinically and
radiologically with serial follow-ups. A clinical hip score based upon the modified
Harris Hip Score (MHHS) was performed pre-operatives and again postoperatively.
Results: During period of study 44 men (73.3%) and 16 women (26.6%) with
a mean age of 31.40 ± 4.08 years (range 25 to 36 years) at the time of presentation
were entered. The mean surgical time was 2.6 ± 0.38 hrs. The mean hospital stay was
3.50 ± 0.72 days. Haemoglobin level decreased significantly after operation (P =
0.046). There was no reported patient with perioperative death, deep venous
thrombosis, pulmonary embolism, infection, dislocation, periprosthetic fracture or
heterotrophic ossification. The mean pre-operative MHHS score was 47.93 ± 7.33 in
patients. MHHS score improved to 95.06 ± 3.47 in the last follow-up (P =
0.0001).
Conclusions: Our results recommend the use of one-stage BTHA through
Hardinge approach in femoral head avascular necrosis patients.
eP1-446 HIP PROBLEMS MIMICKING GYNECOLOGIC PATHOLOGY. CASE REPORT AND REVIEW:
HIP AS A SOURCE OF GROIN PAIN
Ashberg L, Close M, Perets I, Chaharbakhshi E, Walsh
J, Domb B
American Hip Institute, Westmont, USA
Case study: Groin pain and pain around the pelvic girdle in female
patients can have multiple etiologies and symptoms can be confusing. The purpose of
this paper is to emphasize the possibility that intra-articular hip pathology may be
the source. This may minimize the need for gynaecologic workup and possibly,
unnecessary intervention. A 58-year-old female presented with a history of
persistent groin pain, despite gynaecologic surgery. Her clinical workup, confirmed
her hip as the source of her pain. She was found to have an acetabular labral tear
and radiographic findings of femoroacetabular impingement for which she underwent
arthroscopic hip surgery. Intra-articular hip pathology is common and can present
with groin pain. This should be considered in the workup of all female patients.
eP1-425 ONE YEAR RESULTS FOLLOWING HIP ARTHROSCOPY FOR NON-ARTHRITIC HIP
PATHOLOGY IN A DISTRICT GENERAL HOSPITAL
Silk G, Vetharajan N, Dass D
Weston General Hospital, Weston Super Mare, UK
Introduction/objectives: A cohort of patients underwent a hip
arthroscopy review using the Non Arthritic Hip Score (NAHS) proforma. We looked at
patient pain scores pre and post hip arthroscopy. 23 patients were included, with
completed scores for pre op and at one year post scope. All surgeries were completed
by the same surgeon and patients were questioned using the NAHS pre surgery and at
one year post surgery.
Methods: The NAHS is a set of 20 questions regarding pain in the past 48
hours, ranging from 4 = none to 0 = extreme pain for each question. Therefore, a
lower score is worse. The maximum score is 80 (no limitation) to 0 (incapacitated).
Activities questioned include walking on the flat, going up or down stairs, to high
demand sports.
A literature review of “The nonarthritic hip score: reliable and validated.
Christensen CP et al. Clin Orthop Relat Res. 2003 Jan;(406):75-83” was compared to
the Harris hip score and the Short form-12. We found the NAHS to be clinically and
statistically as valid and easier to understand for both the patients and the
author.
Results: 14 males and 9 females. Average age 48 (20 to 78). 14 of the 23
patients reported a significant improvement in their pain scores post arthroscopy
(61%). 9 patients reported an improvement in their pain scores to greater than 60
(39%). However, 9 reported a worsening in their pain post arthroscopy (39%).
Conclusions: On average −61% of patients report an improvement to their
pain levels post arthroscopy at one year. Men improve by 17% and women improve by
24% on their NAHS scores. This shows that hip arthroscopy for non-arthritic hip
pathology is a valid intervention with a good outcome for the patients, with an
average of a 20% improvement in their NAHS score post operatively at one year.
eP1-72 ARTHROSCOPIC LABRAL REPAIR AND OPEN CAPSULAR PLICATION (ALOCAP) FOR
ACETABULAR LABRAL TEAR WITH BORDERLINE HIP DYSPLASIA: A CASE REPORT
1Department of Orthopedic Surgery, Akita University, Akita city, Japan;
2Akita Hip Research Group, Akita city, Japan
Case study: Acetabular labral tears occur due to not only
femoroacetabular impingement, but also developmental dysplasia of the hip (DDH). In
DDH, instability is not improved by arthroscopic labral repair alone. Pelvic
osteotomy is thus used for labral tears with DDH. However, whether cases of
borderline dysplasia with a centre-edge (CE)-angle of around 25 degree need pelvic
osteotomy remains unclear. We performed arthroscopic labral repair and open capsular
plication (ALOCAP) by mini-open direct anterior approach for labra tear with a
CE-angle of 25 degree.
A 51-year-old man reported left groin pain after running upstairs. Flexion range of
the left hip joint was 130 degree with pain and the abduction range was 45 degree
without pain. Anterior impingement sign was positive on the left side. X-ray imaging
showed no joint space narrowing and a CE-angle of 25 degree. Alpha angle was 60
degree on the left. In other words, borderline dysplasia and Cam lesion were
observed. Magnetic resonance imaging revealed an acetabular labral tear.
Intra-articular injection was effective only transiently, so ALOCAP was performed.
None of the symptoms present pre-operatively were seen at 4 months postoperatively.
Pelvic osteotomy is used for labral tears with DDH. However, borderline dysplasia
may not need osteotomy. Arthroscopic labral sutures are effective for labral tears,
but arthroscopic labral sutures require cutting of the joint capsule. Instability
worsens when the capsule is cut. Sewing up the capsule arthroscopically is
difficult, but sewing up the capsule using a mini-opening is very easy. This new
procedure for ALOCAP is easy and effective for reducing pain without worsening
instability.
eP1-368 EARLY OUTCOME OF HIP ARTHROSCOPY FOR THE TREATMENT OF PINCER
FEMOROACETABULAR IMPINGEMENT
Aboelnasr K
Suez Canal, Portsaid, Egypt
Introduction/objectives: Femoroacetabular impingement (FAI) is
recognized as a cause of hip pain in young adults and as a precursor to
osteoarthritis. Labral tears have been described in association with FAI. It is not
clear as to whether arthroscopic labral debridement can improve patient
symptoms.
Methods: Eleven patients with FAI pincer-type lesion were treated with
arthroscopic labral debridement. The presence of FAI was confirmed pre-operatively
on plain radiograph and MRI. The clinical (Merle d'Aubigné) score was used
pre-operatively and at 1 year postoperatively. Comparisons were made using the
Wilcoxon Mann-Whitney test for ordered categorical variables and using the
independent-samples t-test for continuous variables.
Results: The mean Merle d'Aubigné score improved from 10 points (range =
7-11 points) pre-operatively to 17 points (range = 14-18 points) at 1 year
postoperatively.
Conclusions: Arthroscopic labral debridement for pincer type of FAI
significantly improves patient symptoms and gives rapid functional recovery.
eP1-386 RECONSTRUCTION OF THE ACETABULAR LABRUM WITH AUTOLOGOUS CAPSULE VIA
ARTHROSCOPIC ASSISTED DIRECT ANTERIOR MINI OPEN APPROACH
Case study: Over the past 10-15 years investigation of the hip joint has
continued to increase, leading to a better understanding of its function and
anatomy. Surgical treatment options for the hip have progressed significantly with
the aim of maintaining and preserving the hip's anatomy, for example labral repair
and the correction of femoroacetabular impingement. With greater knowledge of the
important role of the labrum with regard to stability and joint movement, labral
reconstruction using different allografts has been described first via open
dislocation and recently using different arthroscopic techniques, and promising
results have been observed. We describe labral reconstruction using local capsular
tissue via an arthroscopically assisted mini-open anterior approach as a novel
method of restoring the integrity of the labrum.
This approach allows a good visualization of the defect and preparation of the
acetabular rim. In addition there is less donor-site morbidity compared to other in
place and a good overview for the labral reconstruction with the local capsule
tissue compared to an all-arthroscopic techniques. Thus, our approach allows the
arthroscopy of the hip joint after augmentation and specific cartilage therapy if
needed. Compared to arthroscopic techniques describing labral reconstruction with
local capsular tissue in our technique the capsule is closed and we did not observe
instabilities of the hip joint at 40° flexion and 10° external rotation.
Nevertheless a limitation of our technique is that the role of hip capsule and
especially the iliotibial band is unclear, when being potentially weakened when
compared to other autografts like ITB or the gracilis tendon.
eP1-22 AUTOLOGOUS CONDITIONED PLASMA (ACP) INJECTION FOR THE TREATMENT OF
CHRONIC TROCHANTERIC BURSITIS AFTER TOTAL HIP REPLACEMENT
Rajeev A1, Skindilias Y2,
Kashyap S2
1Queen Elizabeth Hospital, Gatesheah Health NHS Trust, Gateshead, UK;
2Queen Elizabeth Hospital, Gateshead, UK
Introduction: Trochanteric bursitis is one of the causes for painful
total hip arthroplasty (THR). The incidence of trochanteric bursitis after THR is
4-17%. The treatment options are NSAIDS, corticosteroid injections, ultrasound and
shock wave diathermy with variable outcomes. The aim of our study is to
prospectively assess the results after ACP injection.
Methods: Thirty two patients with severe chronic greater trochanteric
bursitis following total hip replacement who had a minimum of 6 months of
traditional nonoperative were included in the study. All the patients had Hardinge's
approach to hip. The patients were scored pre-operatively with Harris Hip Score
(HHS) and pain assessed using VAS. The plasma was prepared using Arthrex kit. The
plasma which was separated is injected in to the trochanteric bursa under local
anaesthesia as a day patient. All patients were allowed to immediately return to
normal activities as tolerated. The patients were evaluated at 3 months, 6 months
and one year after the injection with Harris hip score and VAS.
Results: There were 12 males, 20 females. The age group ranged from 68
to 82 (average 76.2). The pre-treatment HHS were 54 (48-60) and VAS was 7.8 (7-8).
The post-treatment HHS initially improved to 78 (62-84) and VAS of 4.5 (3-5) at 3
months. The HHS after 6 months were 72 (64-80) and VAS 5.4 (5-6). At one year the
HHS dropped to 68 (54-74) and VAS was 6.7 (5-8).
Discussion: The cause of trochanteric pain after THR is multifactorial,
most often of unknown aetiology. Platelet Rich Plasma has been tried in
non-arthroplasty patients with good results. The Arthrex ACP System provides rapid
and efficient concentration of platelets and growth factors from autologous
blood.
Conclusions: Our study suggests that the use of ACP injection is
significantly more effective for the treatment of severe chronic greater
trochanteric bursitis after total hip replacement in the short term.
eP1-358 ISCHIOFEMORAL IMPINGEMENT SYNDROME: CASE REPORT AND REVIEW OF THE
LITERATURE
Bilgen öF, Mutlu M, Yaray O
Private Medicabil Hospital, Bursa, Turkey
Case study: Ischio-femoral impingement syndrome (IFIS) is a rare cause
of hip pain. It is caused by narrowing the space between lesser trochanter of femur
and ischial bone. And the quadratus femoris in this space is exposed to compressive
injury.
26 years old man having pain on left hip for 18 months admitted to hospital. In
physical examination there was pain in combination of flexion, adduction, supination
and in combination of extension, adduction, and pronation at left hip. He had a
sport injury on left hip in 2001. The ischio-femoral distance (IFD) was 25 mm on
right hip and 4 mm on left hip on AP pelvic x-ray, and on hip MRI was 6.5 mm. Under
general anaesthesia in prone position a transverse incision was made on left gluteal
sulcus. After ischium was reached, wedge resection osteotomy, parallel to left
ischium base was carried out. The fragments were fixed with 2 wires. The patient was
allowed partial weight bearing for 3 weeks then full weight bearing was allowed. His
symptoms were improved in the 2-month and in physical examination full ROM in left
hip was achieved and on AP pelvis x-ray the IFD was 20 mm.
The standard treatment of IFIS is still unclear. Conservative treatment consists of
rest, activity restriction, NSAIDs, exercises. Local anaesthesia and steroid
injections on lesser trochanter could temporary improve the symptoms an also it
could be used as a diagnostic test. Lesser trochanter excision, iliopsoas and
quadratus femoris release with lesser trochanter excision, arthroscopic quadratus
femoris decompression and ischioplasty are the surgical treatment options. IFI
should be considered in patients with hip pain, especially in patients with valgus
hip deformity, and other abnormities leading to narrowing of IFD.
eP1-280 SURGICAL MANAGEMNT OF VALGUS SCFE BY EPIPHYSIAL REALIGNMENT: REPORT OF
TWO CASES
Introduction/objectives: Valgus slipped capital femoral epiphysis
(valgus SCFE) is an uncommon form of SCFE. The reported surgical treatment for acute
and symptomatic cases was similar to the classic SCFE and with in situ pinning or
intertrochanteric osteotomy. Nowadays anatomic realignment of proximal femoral
epiphysis is going to be the optimal management of classic SCFE using extended
retinacular flap technique (ERFT) through surgical hip dislocation. There is no
report of such a treatment in valgus SCFE. Here we report the clinical and
radiographic results in two cases of valgus SCFE.
Methods: two hips in two patients (one male, one female) with valgus
SCFE were treated by subcapital realignment in a 11 years old girl (case 1) and
femoral neck osteotomy in a 18 years old man (case 2). ERFT through surgical hip
dislocation was used in both hips. The mean age of the patients was 14.5 years and
the mean follow-up period was 33 months (range 1.5-4 years). They followed
clinically by Merle d'Aubigne Scale and radiographically for AVN, chondrolysis and
epiphyseal alignment.
Results: The mean pre-operative modified Merle d'Aubigne score was 6 in
case 1 and 11 in case 2 that improved to 18 and 16 in last follow up accordingly.
After operation hip motion was within normal range in both. Epiphyseal shaft angle
(ESA) of 107.5°(range 85-125°) had changed to 60° (range 55-70°) postoperatively.
There was no AVN or chondrolysis. Overall functional improvement was excellent in
first and good in the second case.
Conclusions: Anatomical realignment of proximal femoral epiphysis in
this small series of patients with valgus SCFE had excellent to good results in
regard to motion, pain, and anatomy.
eP1-38 SHORT STEMS IN DOOR FEMORAL TYPE C: A PROSPECTIVE STUDY
Restrepo N
Clinica de Reemplazos Articulares, Pasto, Colombia
Introduction/objectives: Increasing the use of short stems in dysplastic
and proximal femoral deformities, these implants have begun to be routinely placed.
In our department, 97% of our implants are uncemented, being the major cause for the
use of cemented stems (3%), a cylindrical femoral conformation or Dorr type C femur.
With our short stem we obtained good results, we would like to make a prospective
study evaluating osseo integration and clinical improvement with this type of
surgery in C type femurs.
Methods: A protocol for patients with a Door type C femur, who signed an
informed consent allowing us to use the Mini-hip TM uncemented stem in his primary
arthroplasty. This surgery was performed in a unique hospital by the same surgical
team, and designed surgeon. In these patients, postoperative clinical control was
performed at 10-30 days, 6 and 12 months and X-rays films monitoring at 6 and 12
months.
Results: We perform a total hip arthroplasty with the mini-hip short
stem, conjoined with the Trinity acetabular cup (Corin UK) in 58 patients, 32 (55%)
women and 26 (45%) men, whose ages are in the range between 58 to 78 years (average
71 years), all of them with a special femoral conformation classified by Dorr as a
cylindrical Type C femur. After an average follow up of 16 months we found
radiological osseo integration in all our patients, with no complications like
dislocation, fractures or stem subsidence.
Conclusions: In our institution, with this prospective study, we have
changed the protocol for Dorr type C femoral arthroplasties, replacing the cemented
stem for a mini-hip short stem, without complications and a better hospital
discharge.
eP1-111 EFFECTIVENESS OF TWO-STAGE REVISION AND CONSERVATION OF THE FEMORAL
CEMENT MANTLE FOR TREATMENT OF PROSTHETIC JOINT INFECTION IN PATIENTS WITH TOTAL
HIP ARTHROPLASTY WITH EXETER PROSTHESIS
Bjarnason AO, Broeng L
Køge Hospital, Orthopaedic Surgery Department, Køge, Denmark
Introduction/objectives: To retrospectively analyse the postoperative
outcomes of treatment of prosthetic joint injection (PJI) using two-stage revision
and conservation of the cement mantle in patients with total hip arthroplasty
(THA).
Methods: Retrospective analysis of 8 patients with THA treated for PJI
over a 4-year period (2012-2016). All patients had PJI from their primary cemented
THA with Exeter prosthesis. A positive diagnosis of late PJI was considered when 2
or more biopsies revealed a positive count. Patients were treated for PJI using
two-stage revision with the cement mantle in the femoral canal conserved. Age, sex,
time from primary hip to revision, time from first to second stage revision,
follow-up, and results of microbiological cultures were registered. The median
(range) age at the first stage revision procedure was 74 (68-78) years. The median
(range) follow-up time was 14 (12-40) months. At follow-up, a radiological
evaluation together with a clinical evaluation of pain and ability to walk, hip
disability and osteoarthritis outcome score was obtained. Complications concerning
soft tissue and antibiotic treatment were also registered. After the first-stage
revision, antibiotics were administrated intravenously for 2 weeks, followed by ≥4
weeks of per oral treatment. Patients had to be infection-free before the
second-stage revision for 4-6 weeks.
Results: Of the 8 patients treated using two-stage revision and
conservation of the cement mantle, 7 were treated with successful eradication of the
PJI, one patient required one soft tissue revision, followed by 5 weeks of
antibiotic treatment after the second-stage revision, one patient died from cardiac
failure after the first-stage revision.
Conclusions: Two-stage revision with conservation of the femoral cement
mantle is an effective procedure for treatment of PJI in patients with THA.
eP1-58 EVALUATION OF THE HIP JOINT CONTACT FORCE IN SUBJECTS WITH PERTHES
BASED ON OPEN SIMM
Karimi M
Isfahan University of Medical Sciences, Isfahan, Islamic Republic of Iran
Introduction/objectives: The head of femoral bone deformed in subjects
with Leg Calve Perthes Disease (LCPD). It may be due to the excessive loads applied
on it. There is no study evaluated the hip joint contact force in subjects with
LCPD. Therefore, the aim of this study was to evaluate the hip joint contact force
in subjects with Perthes disease.
Methods: Two groups of normal children and those with LCPD were
recruited in this study (each group consisted of 10 subjects). The kinematic and
kinetic of the subjects were evaluated by Qualysis motion analysis system and a
Kistler force plate. The hip joint contact force was evaluated by use of Open SIMM
software. The difference between the parameters was determined by use of two sample
t test.
Results: There was a significant difference between walking speed of
normal and Perthes subjects (63.79 ± 8.14 and 57.4 ± 6.97 m/min, respectively). The
first peak of hip joint contact force was 4.81 ± 1.67 N/BW in Perthes subjects,
compared to 7.58 ± 2.49 N/BW in normal subjects (p value = 0.004). The peak of hip
joint contact force in mediolateral and anteroposterior directions decreased
significantly in Perthes subjects (p value<0.05). The hip joint excursion was 40
± 5.59 and 46.4 ± 8.5 degrees in Perthes and normal subjects, respectively (p value
= 0.03).
Conclusions: The hip joint contact forces decreased in subjects with
Perthes disease to reduce the loads applied on the hip joint. The results of this
study showed that this mechanism is successful to reduce hip joint contact
force.
eP1-164 BONE REMODELLING AFTER TOTAL HIP ARTHROPLASTY WITH TWO DIFFERENT TYPES
OF THE UNCEMENTED FEMORAL STEMS
Shubnyakov I, Tikhilov R, Karagodina M
Vreden Russian Institute of Traumatology and Orthopaedics, S. Petersburg, Russian
Federation
Introduction/objectives: Total hip arthroplasty (THA) is one of the most
popular surgical procedures for patients with a degenerative disease of the hip.
However, a metal stem in a hip can be the reason of periprosthetic bone mineral
density (BMD) loss.
In this study, we are going to evaluate bone remodelling after THA using Fitmore stem
and Alloclasic femoral stems.
Methods: We assessed 46 patients (mean age 58.3) using a Lunar
dual-energy X-ray absorptiometry (DXA) scan around the stems according protocol. The
BMD (g/cm2) of the operated hip was measured using the analysis of seven
Gruen zones.
Results: The first postoperative measurement was performed during the
first two days after THA and further in 3, 6 and 12 months. DXA after 3 months
showed progressive loss of BMD in all Gruen zones, but most significant BMD loss in
zone 2 (-9.7%), zone 7 (-18.3%) for Fitmore stem group, in Gruen zone 6 (-6.7%),
zone 7 (-11.1%) for Alloclasic stem group. At 6 months after THA in all Gruen zones
of Fitmore vs Alloclasic femoral stems there were the phase of moderate
stabilization. At 12 months, we observed an increased periprosthetic BMD in Gruen
zone 3 (1.3%) for Fitmore group, decreased periprosthetic BMD in Gruen zone 1, 7 is
similar of 2 groups. The differences in BMD between the 1 and 2 groups were
statistically significant in Gruen zones 3 (p = 0.033), 5 (p = 0.013) and 7 (p =
0.016).
Conclusions: The assumption that the use of shorter femoral components
contribute to less bone loss proximal femur is not supported by the study of
adaptive remodelling of periprosthetic bone throughout the year. The most
significant changes of the mineral density depends on the geometry of the implant
and its position in the medullary canal.
eP1-121 CEMENTLESS TOTAL HIP REPLACEMENTS WITHOUT FEMORAL OSTEOTOMIES IN
SEVERE DYSPLASIA CASES - A VALID OPTION
Aleixo H, Camelo N, Carvalho L, Fernandes L, Castro
D, Lino T, N. Araújo S
ULS Matosinhos - Hospital Pedro Hispano, Matosinhos, Portugal
Introduction/objectives: Hip dysplasia and joint abnormalities are
clearly accepted as possible precursors of osteoarthritis nowadays. Along with the
pursuit of information to completely understand the disease, its treatment can be
challenging.
We briefly review the development of the concept of dysplasia and its classification,
the options available for treatment today and present two Crowe IV dysplastic hip
and the solution provided.
Methods: The patients had a pre-operative diagnosis of Crowe type IV
dysplasia. Clinical information, details of the operation and the results of
clinical and radiological assessments were prospectively collected and recorded as
part of routine practice. The data collectors were the main author and the senior
author. The prosthetic material chosen was a trabecular titanium cup and a
hydroxyapatite-coated cementless modular stem. The bearing surface was third
generation ceramics, according to the local preferences. In one of the cases, there
was a need for using an external augment, also of trabecular titanium. Screws for
cup fixation were used in both. All the chosen material was from the same
manufacturer. We assessed pre and post-operative over-all satisfaction and the
Harris hip score (HHS).
Results: The mean age of the patients at surgery was 42.5 years (40 and
45). One of the patients had a femoral osteotomy previously, which was united by the
time of the surgery. Both surgeries were performed by the senior author using a
modified Hardinge approach. No complications registered so far. The mean HHS pre-op
was 40 (35-45) and improved to 90 (85-95). The centre of rotation was corrected and
components are well positioned.
Conclusions: Cementless total hip replacements without femoral
osteotomies can be a valid option even in severe dysplasia cases.
eP1-174 THE EVOLUTION OF AN UNCEMENTED ACETABULAR COMPONENT IN
ALUMINA-ON-ALUMINA TOTAL HIP REPLACEMENT HAS IMPROVED CLINICAL OUTCOME. A
PROSPECTIVE, COMPARATIVE FIVE- TO 15-YEAR FOLLOW-UP STUDY
Garcia-Cimbrelo E, Garcia-Rey E, Cruz-Pardos
A
Hospital La Paz, Madrid, Spain
Introduction/objectives: Although the tribological characteristics are
excellent, cup fixation has been one of the limitations in alumina-on-alumina total
hip replacement (THR), so different types of materials and surfaces have been
developing. We assess possible differences in result due to evolution of the
uncemented acetabular component design in alumina-on- alumina THR by comparing two
groups of patients.
Methods: We compared 342 hips operated between 1999 and 2005 with a
relatively smoothed hydroxyapatite cup (group 1), and 337 hips operated between 2006
and 2011 using a cup with a macrotexture on the entire outer surface of the shell
(group 2). Clinical and radiological results were assessed including cup position
and hip rotation centre distance according to Ranawat. Survivorship and Cox
regression analysis were used to evaluate the risk for cup loosening.
Results: No hips were revised due to complications related to alumina or
to stem loosening. Fifteen cups were revised for aseptic loosening in group 1 and
two in group 2. The survival rate for cup aseptic loosening was 95.6% (95% CI: 93.4
to 97.8) at 15 years for group 1 and 99.2% (95% CI: 98.0 to 100) at 8 years for
group 2. The risk for aseptic cup loosening was higher in group 1 (p = 0.04, Hazard
ratio (HR): 4.99), dysplastic acetabulae (p = 0.01, HR: 4.12), cups outside
Lewinnek's zone (p<0.001, HR: 6.13) and in those with a hip rotation centre
distance greater than 5 mm (p = 0.005, HR: 4.09).
Conclusions: Alumina-on-alumina uncemented THR is an excellent option
for young patients. Although newer cups improved bone fixation, acetabular
reconstruction is essential to obtain a satisfactory outcome.
eP1-305 AMISTEM-H RADIOLOGICAL ASSESSMENT: 5 YEARS OUTCOME
Vié P
Clinique Du Cedre, Bois Guillaume, France
Introduction/objectives: Cementless total hip replacement (THR)
preserves bone vitality around the prosthesis. It reduces the prevalence of
periprosthetic osteolysis and long-term loosening of components. The short curved
AMIStem design facilitates implantation in anterior approach and allows bone stock
preservation. The aim of the current clinical study is to evaluate the clinical and
radiological performance of AMIStem-H five years after implantation.
Methods: It is a retrospective, single-centre, single-surgeon study on a
series of 81 patients (83 hips) who received cementless stem AMIStem-H (Medacta
International SA, Castel San Pietro) at 5 years follow-up. All surgeries were
performed by the AMIS technique (Anterior Minimally Invasive Surgery) with the
mobile leg positioner AMIS (Medacta). Pain and activity levels were collected. At 5
years follow-up, 2 patients died and 2 were lost to follow-up. Osteointegration of
the stem and greater trochanter fractures were noted. The periprosthetic radiolucent
lines were evaluated according to Gruen zones.
Results: At 5 years, 97% of patients had no or mild hip pain and 3%
slight pain. 2 traumatic femoral fractures that didn't require a stem replacement
and one femoral neck ossification occurred. No stem fracture, no significant
subsidence, no endosteal cavitations or resorption of the medial neck and no
critical radiolucencies were observed. No revisions were performed and the survival
rate at 5 years was 100%.
Conclusions: These results suggest that the AMIStem can be used safely
and effectively for the surgical treatment of degenerative and inflammatory diseases
of the hip in THR for a wide range of patients.
eP1-146 STRESS-SHIELDING AFTER TOTAL HIP ARTHROPLASTY WITH DIFFERENT KINDS OF
STEM DESIGN
Pidgaiska O, Filipenko V
Sytenko Institute of Spine and Joint Pathology, Kharkiv, Ukraine
Introduction/objectives: 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. Cementless designs differ from one another in terms of
geometry and the means of obtaining initial fixation. The purpose of this study was
to investigate the appearance of stress- shielding at different stem designs and how
the shape of femoral canal can influence the stability of implant.
Methods: The results of 128 total hip arthroplasties performed in 119
patients with insertion of different types of femoral components (short stems,
Muller stems of metaphyseal fixation and distal type of fixation) without cement
were reviewed retrospectively to determine the stability, signs of stress-shielding
and aseptic loosening. The average duration of clinical and radiographic follow-up
was 7.6 years (range 5.0 to 8.5 years). Estimation of stem fitting was made
according to the shape of femoral canal by P.C. Noble classification.
Results: Radiographs demonstrated stable fixation in 98 cases (82%).
Signs of stress-shielding were observed in 19 patients (16%), aseptic loosening - 5
cases (4%), stress-shielding preceded to stem loosening in 3 cases (2.4%). At the
time of the latest follow-up, 16 patients reported that they had mild pain related
to the hip. Three patients had revision operation on the cause of stem loosening.
Due to statistical analysis the risk of pathological bone remodelling after THA was
calculated. It was revealed that the result of arthroplasty at “stovepipe” shape of
femoral canal statistically (p = 0.002) depended on the type of femoral
component.
Conclusions: Stem design and the shape of femoral canal should be taken
into consideration at pre-operative planning.
eP1-204 CFP STEM, THE SECOND GENERATION OF THE FEMORAL NECK PRESERVING:
RESULTS IN 15 YEARS FOLLOW-UP
Palermo A1, Cannizzaro S1,
Marconi G2
1Istituto Auxologico IRCSS Capitanio Milano, Milan, Italy;
2Casa di Cura Villa Fiorita, Prato, Italy
Introduction/objectives: The concept of femoral neck preservation proved
to be successful from the beginning. Also long term follow up showed that the
femoral neck preservation can guarantee many advantages:
- bone stock preservation;
- respect for bone structure;
- respect for muscle tension throughout off-set preservation.
Methods: CFP stem, by Link Company (Collum Femoris Preserving), is an
anatomical stem that respects cervical shaft angle and neck antiversion. Two
different curves (A, B) and two neck orientation angles, respectively of 117 and 126
degrees, are available and the presence of a removable support collar, at the level
of a neck osteotomy, offers different implant opportunities, making the C.F.P.
similar to a modular stem, without the disadvantages of the real modularity. This
stem design guarantees the respect of proximal trabecular bone and the continuity of
their trajectory with the pelvis. The great primary mechanical and metaphyseal
stability is due to the intersection of two cylinders, with the result of an
important press-fit and a great torsional stability. Medium and long-term results
demonstrate that the use of the collar is sometimes useless, since proximal stress
loads is evenly distributed, as showed in DEXA analysis. Off-set improvement,
guaranteed by the stem curvature and femoral neck conservation, is showed by a rapid
patient's joint functional recovery, with a reduction in Trendelemburg, during
walking. The possibility to choose between two different curves makes it possible to
customize the implant, according to different articular morphologies, but in order
to do that, it is necessary to create a precise pre-operative planning. Number of
patients with A curve stems was higher than number of implants with B curve. This
kind of choice has been influenced not only by replaced hip morphology, but also by
neck osteotomy height, performed by surgeons. Shortest femoral neck osteotomy,
usually leads to the choice of an implant with A curve. One of the problems faced in
that kind of implant, especially for first time and less experienced users, was the
risk of stretching the leg. This mistake has been made by those surgeons who, in
order to preserve all femoral neck, believed it was necessary to practice neck
osteotomy too, under the head. However, to implant C.F.P. stem correctly and in
order to preserve the femoral neck, it is sufficient to practice an osteotomy at one
and a half centimetre from piriformis dimple. To choose the right curve and
osteotomy height, it is essential to use a precise radiographical pre-operative
planning and in order to achieve that, you need an x-ray with 20 degrees
intrarotation of the leg you have to operate. This guarantees an improvement in the
choice of curve and consequently, a higher risk control for leg dysmetria. The cases
found in aseptic loosening were rare and due to surgical technique mistakes about
undersized stem. C.F.P. however, is not a cortical fit stem, but an implant that
compresses and respects cancellous bone.
Results: In this presentation we are showing a 15 year follow up, with
clinical analysis in patients made by Harris hip score and x-ray analysis, with
radio-graphical parameters following Tom Gruen division. All the host bone segment
has been valued with DEXA analysis on 40 patients, making tests of reproducibility
on DEXA EXPERT equipment.
Conclusions: We will report our clinical and X-Ray results with that
kind of implant, from its birth until today.
eP1-303 THE ANATOMICAL CONCEPT IN HIP STEM: LEARNING FROM THE PAST
Franceschini M, Calabro' F, De Bartolomeo O, Mineo
G
Istituto Ortopedico Gaetano Pini, Milan, Italy
Introduction/objectives: The design of the femoral component in THA has
a key role because it influences the implant stability and the long-term survival of
the prosthesis. With our long lasting experience on anatomical stem, one year ago we
started implanting a new hip stem, the Link SPCL. With this study we want to point
out anatomical stem features and qualities.
Methods: We analysed retrospectively 62 consecutive cases of
coxarthritis treated with SPCL anatomical stem in 2015. We compared our series with
similar studies founded in literature. Our study was focused on the femoral
component properties and on both clinical and biomechanical benefits. We used Harris
and Oxford Hip Scores and x-ray assessment at 3, 6 months and 1 year postop. We
furthermore studied with a finite element model the stresses distribution on the
femur comparing a straight with an anatomical stem.
Results: The correct antiversion angle, the optimization of the size and
the better implant geometry gave good radiological results in our records. Harris
and Oxford Hip Scores demonstrated excellent clinical improvement at 3 and 6 months,
in particular if the implant was associated with the direct anterior approach (DAA).
Complications were: 1 heterotopic ossification and 1 intraop periprosthetic
fracture. The biomechanical study confirmed a better distribution of the forces for
the anatomical stem.
Conclusions: In our opinion the anatomical stem may be preferred to
straight stems for biomechanical factors. It guarantees optimal stability of the
implant, furthermore the anatomical design allow less mechanical stress on the femur
reducing thigh pain and periprosthetic fracture risk.
eP1-100 METALLOSIS AND PSEUDOTUMOR AROUND CERAMIC-ON-POLYETHYLENE TOTAL HIP
ARTHROPLASTY: CASE REPORT
Taheriazam A1, Safdari F2,
Saeidinia A3
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Shahid Beheshti University of Medical Sciences, Bone,
Joint and Related Tissue Research Centre, Tehran, Islamic Republic of Iran;
3Guilan University of Medical Sciences, Rasht, Islamic Republic of
Iran
Case study: Polyethylene failure is a rare complication of
ceramic-on-polyethylene total hip arthroplasty due to characteristics of ceramic.
Complications associated with ceramic-on-polyethylene articulations have been
studied extensively, however, only few reports have described its catastrophic wear
and concurrent pseudotumour formation. The etiology of this biological reaction and
concurrency of pseudotumour formation with metallosis remain unclear. We report two
cases of wear of the acetabular liner in a ceramic-onpolyethylene prosthesis due to
total hip arthroplasty (THA) long time ago. They came back to the clinic with the
history of worsening hip pain and abnormal radiological and clinical findings. Then
they underwent surgery and metallosis and pseudotumours were detected and revisions
were performed for them. It is necessary to evaluate patients who underwent THA
complaining of hip pain for component wear and check that the cup appears well
fixing and fairly oriented on follow-up radiographies. Close follow-ups can prevent
accelerated polyethylene wear in ceramic-on-polyethylene coupling THA.
eP1-230 DIRECT ANTERIOR APPROACH AND ANATOMICAL FEMORAL STEM FOR PRIMARY THA.
MID-TERM OUTCOME IN 500 CASES
Asparuhov A, Valeshkov Y
University Clinic of Orthopaedics and Traumatology, Pleven, Bulgaria
Introduction/objectives: The goal of this report is to evaluate the
results of a direct anterior approach with cementless anatomical short stem in
young, active patients.
Methods: Results of 500 consecutive THA performed between 2008-2011 are
reviewed in a Fup of at least five years. The mean age at the time of the operation
was 53 years. The reason for op are: pr OA-441 cs; AVN-56 cs; Fx femoral neck-3cs.
simultaneous op- 86 cs. Used cementless anatomic stem- ABGII in all css.
Period of Fup- 60 months (449cs). Lost for Fup-50 cs; death- 1 cs (pulmonary Ca)
Items for F up are: achievement of rehabilitation milestones; cane usage;
complications.
Results: Harris Hip score was altered to 90 points (92.2-6.48) in
comparison with the initial values −30.01 ± 13.25. At the control radiographic
examination the stem position was good in the neutral position or slight valgus
(<5° of varus) except in 5 cases in a varus position, with most frequent reason
being the implanting of a smaller than the necessary size of femoral stem. At the
last Fup there are not cases with heterotopic ossification. Complications included
fx of the lateral femoral cortex (intra- op)-2cs, malposition of the stem-2 cs,
varus position of the stem in 5 cases, postoperative dislocation - two patents with
a long-standing posttraumatic OA. Late infection (>2 y) −2 cs. 24% of the
patients reported for a certain extent of hipoaesthesia.
Conclusions: The anatomical ABG II HA stem for cementless fixation has
shown encouraging results with primary and mid-term stability. Restoration of
leg-length equality is not difficult with a direct anterior single-incision
mini-approach. The less surgical dissection and reduced blood loss make possible to
replace both hips simultaneously as a single procedure with one anaesthesia.
eP1-306 POSTEROLATERAL VERSUS LATERAL APPROACH IN TOTAL HIP ARTHROPLASTY, A
PROSPECTIVE STUDY
Introduction/objectives: Decision making about the approach of the total
hip arthroplasty (THA) is often based on the surgeon's preference and local
traditions. An ongoing debate is available in the literature about the best approach
of THA. The purpose of the study was to compare the early results of lateral versus
posterolateral approaches in THA.
Methods: It is a prospective non randomized cohort study. 137 hips in
120 patients divided in two groups for primary THR. 79 cases in the lateral (L) and
55 in posterolateral (PL) group. All the patients received enoxaparin for
prophylaxis of VTE. Clinical and radiographic evaluation documented at 6, 12, 24, 48
weeks after surgery. Post op evaluation includes pain visual analog score (VAS),
Harris hip score (HHS), blood loss, and major clinical complications and
radiological evaluation. Mean follow up was 17 months (12-30).
Results: There was no significant difference between two groups
regarding demographic data as well as pre-operative diagnosis. Clinical results
showed that HHS doubled 12 weeks after surgery in both groups. Regarding pain there
was less pain in PL group at 6 weeks after surgery but it was not significant and it
were the same after that. Blood loss (430 cc in L versus 460 cc in PL) was the same.
There were four proximal femur fractures in L and two in PL group (p = 0.22) managed
by wiring. There were 2 infections and 4 DVT with no significant difference.
Dislocation happened in two cases equal between two groups. Radiographic evaluations
revealed no difference.
Conclusions: Our study showed that PL and L approaches have similar
clinical and radiological results in THR after one year, which is consistent with
other studies. There was less pain in posterolateral group at six weeks but after 12
weeks patients feel the same level of pain.
eP1-299 THE EVALUATION OF RESULTS OF PERIPROSTHETIC FRACTURE TREATMENT IN
PATIENTS WITH HIP OSTEOARTHRITIS CAUSED BY RESIDUAL DYSPLASIA OF THE HIP JOINT
WITH DISLOCATION OF TYPE III AND IV ACCORDING TO THE CROWE'S
CLASSIFICATION
Sionek A, Czubak J, Czwojdzinski A, Grochowski
K
Department of Orthopaedic, Paediatric Orthopaedic CMKP, Warsaw, Poland
Introduction/objectives: One of accepted methods of operative treatment
of young adults with osteoarthritis (OA) coming as the sequeleae of developmental
dysplasia of the hip with dislocation (DDH) is total hip alloplasty (THA).
The aim of this study was to determine the frequency of periprosthetic fractures
occurring and to assess the results of treatment of this complication.
Methods: In years 2009-2015 we operated 91 hip-joints of 81 patients
with OA as a sequeleae of DDH with dislocation of type III and IV according to
Crowe's classification. Mean age was 32 years old (from 15 to 64). For the purpose
of the study two groups of patients operated from postero-lateral approach were
established.
Group “A” consisted of 10 hips of 10 patients treated with the use of Accolade stems.
Group “B” consisted of 81 hips of 71 patients, treated using Wagner's stems. In
group “A” the follow-up period lasted from 3 to 7 years, and in group “B” from 1 to
7 years. Frequency of periprosthetic fractures were noted. The results were assessed
clinically according to HHS and radiologically.
Periprosthetic fracture was observed in 4 out of 10 hips from group “A” and in 6 from
81 hips from group “B”. The differences were statistically significant. All patients
with periprosthetic fracture were treated using metal cables.
Results: In clinical and radiological assessment improvement was
obtained in all patients. Decreased frequency of periprosthetic fractures in
patients with OA as a sequeleae of DDH was noted in all patients treated using cone
stems.
Conclusions: Patients with OA as a sequeleae of DDH with hip-joint
dislocation of type III and IV according to Crowe's classification should be treated
using cone stems.
eP1-143 TRABECULAR METAL CUPS IN COMPLEX PRIMARY TOTAL HIP ARTHROPLASTY.
SURVIVAL AND CLINICAL OUTCOMES
Capurro Soler B1, Sala Pujals
A1, Gamba C1, Marí Molina R1, León García
A1, Tey Pons M2, Marques López F1
1Hospital del Mar - Parc de Salut Mar, Barcelona, Spain;
2Hospital del Mar - Parc de Salut Mar, ICATME - Hospital Universitari
Quirón Dexeus, Barcelona, Spain
Introduction/objectives: A complex Primary total hip arthroplasty (CTHA)
presents a challenge to achieving a stable acetabulum. The aim of this study was to
assess survival and clinical outcomes in CTHA using uncemented trabecular metal
acetabular implants (TMARS, Zimmer Inc., Warsaw, Ind).
Methods: A retrospective study of 20 surgeries using TMARS in CTHA
conducted between April 2005 and June 2015 was done. We included hip dysplasia Crowe
type ≥2, sequelae Perthes disease (PD) and sequelae from a traumatic pathology. Data
was obtained from the hospital's electronic records. Evaluations were performed
using the Merle d'Aubigné-Postel (MAP) score. Statistical analysis was performed
using SPSS 18.0.
Results: The mean age was 53.5 (32-85) years and BMI 28.3 (21.7-42.8).
Hip dysplasia accounted for 11 cases. There were also 2 PD, 3 acetabular fracture
dislocations, 2 early osteosynthesis failures for proximal femur fractures and 2
arthrodesis to THA conversions. The mean follow-up was 4.4 (0.7-10.8) years. The
mean MAP score improved from 12.4 to 16.6 (p = 0.001). There were no cases of
radiological loosening. Intraoperative complications consisted of two cases of
proximal femur fractures resolved with cerclage wires and one case with conservative
treatment of a marginal acetabulum fracture. Postoperative complications included
one case of infection, two dislocations and one peroneal nerve palsy. No differences
in survival rates and postsurgical MAP scores between the different diagnoses and
surgical indications or in intraoperative and postoperative complications were
found.
Conclusions: TMARS appears suitable for use in CTHA, showing significant
clinical improvement, a high survival rate with a low rate of complications and no
aseptic loosening.
eP1-361 SINGLE-TIME ARTHROPLASTY IN A 25Y MILITARY FEMALE WITH BILATERAL
CORTICOID-INDUCED OSTEONECROSIS - CASE REPORT
Pádua M, Pato M, Amaral F
Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
Case study: Osteonecrosis of the femoral head is a metabolic condition
that causes progressive collapse of the femoral head, with progression to secondary
osteoarthritis. It is commonly bilateral and predominantly affects males between 40
and 50 years.
A 25-year old female presented to our clinic with chronic bilateral hip pain. She was
working as a military officer, but with progressive impairment of her daily
activities due to pain and gait deterioration. She reported having taken Prednisone
20 mg daily for a period of approximately 17 months for a self-diagnosed skin
condition, which she stopped two years prior to our observation. She was otherwise
fit and well. Hip motion was severely limited at both hips, with a Harris Hip score
of 25 bilaterally. The x-rays revealed Steinberg-grade VI osteonecrosis of both
femoral heads. She was submitted to one-stage bilateral hip replacement through the
Anterior Supine Intermuscular (ASI) approach. Uncemented cups with short uncemented
stems and ceramic-on-ceramic (CoC) bearings were implanted. The patient went to full
recovery of her previous functional status, with a Harris hip Score of 92
bilaterally at 5 months post-op. Early detection of avascular necrosis is paramount
to direct treatment into preserving the shape of the femoral head. When dealing with
advanced osteoarthritis in a young and active patient however, the authors'
preference goes to arthroplasty with uncemented implants with CoC bearings to
minimize the risk of aseptic loosening. The ASI approach is a muscle-sparing
approach, which allows for a single-stage procedure in bilateral disease, with a
faster return to function.
eP1-170 TOTAL HIP REPLACEMENT WITH NONUNION OF THE FEMORAL NECK
Shilnikov V, Tikhilov R, Denisov A, Shubnyakov
I
Vreden Russian Institute of Traumatology and Orthopaedics, S. Petersburg, Russian
Federation
Introduction/objectives: In the presence of arthroplasty femoral neck
non-union causes considerable difficulties for the surgeon, low long-term results
and low survival of the implant.
To evaluate the results of total hip replacement and analyze the cases of possible
complications.
Methods: A total of 176 patients operated on approximately 2010 to 2014
on the nonunion of the femoral neck with a scale Harris, statistical method and
X-ray to determine the stability of the implant components in a year or more after
the arthroplasty.
Results: The functional outcome in a year averaged 83 degrees, which was
significantly lower in osteoarthritis arthroplasty. And directly correlated with the
age of the patients and the degree of recovery of limb length. Marked by a strong
inverse correlation with the continuance of the existence of a false joint. In 7
patients showed instability with cementless acetabular component fixation. 3
patients in the early post-operative period were marked by periprosthetic fracture
of the proximal femur. In 4 patients had a dislocation of the femoral head at
several times after surgery. In 6 patients with acetabular component is installed
protrusion.
The results of arthroplasty patients with nonunion of the femoral neck on functional
status and survival of the implant was significantly inferior in patients with
idiopathic osteoarthritis.
Conclusions: To improve the suitable cement fixation components,
especially in osteoporosis due to the lack of long-term stress on the join. In
addition, to improve the functional result, it is necessary to judge the operation
possibility and expediency of the full restoration of limb length, using specialized
techniques, in particular the definition of muscle tension on Beighton.
eP1-130 TOTAL HIP REPLACEMENT IN SUPINE POSITION
Aminjavaheri S, Mortazavi SMJ
Tehran University of Medical Science, Joint Reconstruction Research Centre, Tehran,
Islamic Republic of Iran
Introduction/objectives: THA through anterior approaches can be
performed in supine or lateral decubitus position. Supine position has its own
advantages and disadvantages. We review our results of total hip surgery in supine
position to see if it is associated with any special problem.
Methods: 198 primary total hip arthroplasty in 156 patients were
implanted in supine position (150 with direct anterior approach and 46 with direct
lateral approach). All operations were performed by single surgeon. All patients
received regional anaesthesia. Leg lengths were assessed introperatively through
direct palpation of the malleoli and heels. We used no hip precaution protocol and
all patients were allowed to have weight bearing as tolerated on the same day of
surgery. Acetabular cup position evaluated on postoperative X-rays.
Results: The average surgical time was 65 minutes. There were no LLD
more than 8 mm in this group of patients. Cup position was in the safe position in
all except two patients. We had three early dislocations, two of them were
associated with excessive cup ante version. In the third one the cup has been
positioned in the safe zone. No anaesthesia related complications were observed.
Conclusions: THA in supine position gives good and reliable exposure of
acetabulum, so it is more likely to put it in the safe position. Putting patient in
supine position is also safer in terms of anaesthesia as anaesthesiologists have
more control on patients in this position.
eP1-104 CONCURRENT ONE-STAGE TOTAL KNEE AND HIP ARTHROPLASTY DUE TO SEQUEL OF
JUVENILE RHEUMATOID ARTHRITIS, A CASE REPORT
Taheriazam A1, Safdari F2,
Saeidinia A3
1Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Islamic
Republic of Iran; 2Shahid Beheshti University of Medical Sciences, Bone,
Joint and Related Tissue Research Centre, Tehran, Islamic Republic of Iran;
3Guilan University of Medical Sciences, Rasht, Islamic Republic of
Iran
Case study: Rheumatoid arthritis is a chronic systemic connective tissue
disease. Total hip and knee arthroplasties are common major orthopaedic procedures
worldwide. To date, no studies have presented one-stage concurrent THA and TKA in
patients with RA. We reported a case which is, to our knowledge, the first
description of both THA and TKA in a patient with RA simultaneously. After more than
a two years follow up time, patient showed excellent clinical function and remained
satisfied with the surgical outcome. Multiple simultaneous TJA is reviewed in this
article.
eP1-44 COMPLICATIONS OF TOTAL HIP ARTHROPLASTY IN DYSPLASTIC DISORDER OF HIP
JOINT, 10 YEARS EXPERIENCE
Savadkoohi D, Siavashi B, Pendar E, Aalirezaei
A
Tehran University of Medical Sciences, Sina Hospital, Tehran, Islamic Republic of
Iran
Introduction/objectives: Total hip arthroplasty (THA) in congenital hip
dislocation and dysplasia (DDH) is a challenging procedure. You have to manage a lot
of problems. Deficient acetabulum, narrow medullary canal, severe anteversion of
femoral neck, valgus neck, thin and weak bone, leg length discrepancy, high riding
head of femur, some muscle contractures, weak abductor muscles are potential sources
of complications. Any of them can lead to complication.
Methods: It is a retrospective study. Every patient with dysplastic
disorder of hip joint which needs total hip arthroplasty between 2005 to 2015 was
studied. Each complication was recorded.
Results: There were 104 total hip arthroplasties in DDH. There were 22
crowe type 4, 32 crowe type 3, 26 crowe type 2 and 24 crowe type 1. There were 6
proneal nerve palsies, 2 femoral nerve palsies, 7 dislocations, 18 remaining LLD, 3
infection, 12 intraoperative periprosthetic fractures, 1 deep venous thrombosis, 1
non-union of osteotomy site, 2 femoral artery injuries.
Conclusions: It is a complicated operation (52 complications in 104
THA). But fortunately, 13 of complications (9 arterial injury, DVT, dislocation and
infection) were major and catastrophic. Most complications were in crowe type 3 and
4 (18 LLD, 2 infection, 5 dislocation, 4 proneal nerve palsy, 2 femoral nerve palsy,
2 femoral artery injury, 10 intraoperative femur fracture, 1 non-union). THA in DDH
specially crowe type 3 and 4 may accompany high complication rates, so careful preop
planning and meticulous intraoperative bone and soft tissue handling is necessary
for diminishing major complications.
eP1-39 THE EVALUATION OF TWO DIFFERENT SURGICAL APPROACHES ACCORDING TO THE
PATIENT SATISFACTION, PLANTAR PRESSURE DISTRIBUTION AND TRENDELENBURG SIGN IN
TOTAL HIP ARTHROPLASTY
1Beyhekim State Hospital, Turgut Ozal Street, Ankara, Turkey;
2Gazi University, Department of Orthopaedics and Traumatology, Ankara,
Turkey; 3Necmettin Erbakan University, Meram Medicine Faculty, Konya,
Turkey
Introduction: In our study, we examined the clinical results and the
differences at the patients who had unilateral total hip arthroplasty surgery with
two different surgical approaches as classical lateral Hardinge approach and Pai
modification of lateral intermuscular approach.
Methods: We selected 28 patients who had been operated because of the
unilateral degenerative hip arthritis. Classical lateral Hardinge approach was
applied to the first group and Pai modification of lateral intermuscular approach
was applied to the second group. The cementless, standart off-set stem was used for
whole the patients. Plantar pressures have measured by EMED-SF pedobarography
device. Trendelenburg's sign has been estimated as grade 1 and grade 2. Clinical
outcome was measured by comparing Harris Hip Scores pre-operatively, postoperatively
and postoperatively at the sixth month.
Results: Demographic data were similar in both groups. When we looked at
the first and second masks, which show the significant part of the stance phase;
contact areas have similarly increased and the changes at the peak pressures were
similar as contact areas. Before the surgery, Trendelenburg's sign was positive in
three patients in the first group and 1 patient in the second group. In the first
group at the sixth month visit, 4 patients had Trendelenburg's sign and 2 of them
had also positive results before the surgery. In the second group only one new
patient had Trendelenburg's sign at the sixth month visit. There were no
statistically differences for both groups in terms of the average Harris Hip Score
at the pre-operative, postoperative and postoperative sixth month visits.
Conclusions: The functional and clinical early results were similar in
both lateral hip approaches for unilateral total hip arthroplasty when superior
gluteal nerve protection, conjoint tendon repair and postoperative rehabilitation
have done well.
eP1-24 THE RELATIONSHIP BETWEEN TWO UNCEMENTED FEMORAL STEMS FOR PRE-OPERATIVE
TEMPLATING
Banks D, Lim J
University Hospital of North Staffordshire, Stoke-on-Trent, UK
Introduction/objectives: There is ever increasing use of uncemented
stems in primary hip replacement surgery and there are various implants available on
the market. As an arthroplasty surgeon, one may be used to templating with one
particular implant.
This study aims to establish a relationship between the sizes of the
Polar® (Smith and Nephew) and Corail® (DePuy) stems to
allow easy cross referencing between these implants when templating and avoid any
intra-operative confusion.
Methods: The Syngo® Imaging XS (Siemens) digital templating
system was used. Corail (Depuy) and Polar (Smith and Nephew) stems of varying sizes
were overlaid in order to identify matching sizes. A formula providing the
relationship between the two stems was calculated.
Results: The following relationship was identified: Polar stem size =
Corai stem size −8.
Conclusions: The use of this simple equation Polar® Stem Size
= Corail® stem size −8 will enable easy and accurate cross-referencing
for surgeons more familiar with one the uncemented components. This will clearly
help Orthopaedic surgeons in training who often rotate through different
institutions each using different systems.
eP1-281 ACETABULAR REVISION WITH UNCEMENTED CUP AND 36 MM HEAD (4 TO 11 YEARS
FOLLOW UP RESULTS)
Kovac S, Strahovnik A, Novak S, Levasic V
Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
Introduction/objectives: The method of acetabular revision depends on
the type of the bony defect. In defects with supportive acetabular rim, primary
hemispherical press-fit cups can be used. With the retrospective research, clinical
results of the primary press fit cup, highly cross linked PE and 36mm heads are
analysed.
Methods: Between 1st January 2004 and 31st
December 2013 1232 total hip revisions were performed in the hospital. In 145 cases,
primary press fit cup made of commercially pure titanium was used. Average size of
the cup was 58 mm (52 to 70 mm) in diameter. There were 82 females and 63 male
patients. Average follow up time of stable cups was 6.3 years (4.3-11.5 y).
Pre-Operative diagnosis was aseptic loosening in 88 cases, septic loosening in 52
cases, other in 5 cases. Pre-Operative and postoperative X-rays were analysed.
Results: There were 5 cases of aseptic cup loosening. Survival
probability at 8 years with loosening due to aseptic reason was 96.4% (CI ±3.1%).
Screws were used in 20 cases. Spongioplasty was done in 14 cases. There was one case
(0.6%) of postoperative dislocation, which occurred during spinal anaesthesia for
contralateral total knee replacement. It was conservatively treated. X-rays were
available in 143 cases (96%). The mean elevation of the hip center was 1.9 mm (CI
95% 1.3-2.5). The average abduction angle of the cup was 41° (25-62°).
Conclusions: Midterm results of the cup are good when the cup was used
in deficiencies Paprosky 1, 2a and in selective cases of 2b and 2c. There was only
one dislocation (which occurred during spinal anaesthesia for contralateral TKA) in
the series although some of the cups were sub-optimally placed. 36 mm head is one of
the factors adding stability of the construct.
eP1-45 PELVIC DISCONTINUITY, AN UNSOLVED PROBLEM IN REVISION TOTAL HIP
ARTHROPLASTY
Savadkoohi D, Siavashi B, Pendar E, Aalirezaei
A
Tehran University of Medical Sciences, Sina Hospital, Tehran, Islamic Republic of
Iran
Introduction: Pelvic discontinuity is a severe acetabular defect in
revision Total hip arthroplasty with complete dissociation of superior and inferior
segments of acetabulum. This study shows mid-term results of treatment of this type
of acetabular deficiencies.
Materials and methods: All of revision total hip arthroplasties were
studied in our instiute. Patients with pelvic discontinuity entered this study.
Pre-operative and post-operative radiographies were compared and also postoperative
complications were considered.
Results: Seventeen patients had pelvic discontinuity. Mean age was
fifty-nine and it was more common in female and rheumatoid arthritis patients.
Different methods of reconstruction of acetabulum were used. Better results were in
those without segmental deficiencies. There were four reoperations: one because of
dislocation, one for aseptic loosening and the other two because of deep
infection.
Conclusions: Complication rate is high (near 24%). If it is possible,
fixation of posterior column and insertion of cementless cup has the best results.
Otherwise, complete reconstruction of acetabulum should be done with cage and
allograft.
eP1-407 MORTALITY AFTER REVISION HIP ARTHROPLASTY FOR PATIENTS OLDER THAN 75
YEARS OLD
Sanchez A, Escobar S, Martinez J
Fundación Valle del Lili, Cali, Colombia
Introduction/objectives: There is controversy in medical literature
regarding revision arthroplasty in very old patients because of possible
complications and high mortality. Life expectancy has increased worldwide and for
Colombia it is around 74 years; 71 for men and 77 for women. The aim of this study
was to evaluate mortality in patients older than 75 years old who underwent revision
hip arthroplasty, determining possible risk factors and improvement in quality of
life.
Methods: Prospective cohort study that included patients older than 75
years old who underwent a revision hip arthroplasty between August 2012 and February
2016. Mortality was calculated and associated complications were registered. Quality
of life was measured with the Oxford hip score.
Results: Twenty-five cases were included. The mean age of patients was
81 ± 5 years and most were women (76%). The first cause of revision was infection
(36%). There were comorbidities in 56% of cases with no association with mortality.
In 36% of the cases a complication was reported. Mean follow-up was 10.2 months and
mortality was 16% (n = 4). Quality of life improved in the Oxford hip score from a
mean value of 10 to a mean value of 28.
Conclusions: Revision hip arthroplasty in patients older than 75 years
old is associated with an important percentage of complications, nevertheless all
cause mortality was lower than what has been published in literature. Revision hip
arthroplasty improves quality of life in these patients and should be considered in
a case-by-case analysis.
eP1-278 MID-TERM RESULTS OF METAL-ON-METAL TOTAL HIP ARTHROPLASTY
1Ohkubo Hospital, Tokyo, Japan; 2JCHO Saitama Medical Center,
Saitama, Japan
Introduction/objectives: Numbers of papers have been published
concerning adverse reactions to metal debris (ARMD) following metal-on-metal (MOM)
total hip arthroplasty (THA). Some patients who experience ARMD require revision
surgery.
The aim of this study is to evaluate the mid-term results of MOM THA
retrospectively.
Methods: We reviewed all patients who underwent THA from January 2007 to
December 2010. MOM was used in 37 out of 214 cases (17%). PINNACLE cup system was
used in 14 cases, and M2a-Taper system was used in 23 cases. The original diseases
are 28 osteoarthritis, 5 osteonecrosis, 3 rheumatoid arthritis and 1 rapidly
destructive hip coxarthropathy.
We investigated the revision rate of each system and cup positions (anteversion and
inclination) were assessed. We used CAT scan or MRI to assess aseptic loosening,
metal hypersensitivity reactions, and pseudotumour formation.
Results: Six women with osteoarthritis experienced significant localized
soft tissue reactions, and revisions were done. The average duration to revision was
41 months (range, 28-63). The revision rate of PINNACLE cup system and M2a-Taper cup
system was 28.6% and 8.7% respectively. There was no statistical difference between
these systems (p = 0.17 Fisher's exact test). Four patients had no signs nor
symptoms, 1 patient complained of anterior thigh dullness and 1 patient had
dislocation. The average cup anteversion was 15.7 degrees and the average
inclination was 49.2 degrees.
Conclusions: MOM THA had higher incidence of revision due to localized
soft tissue reactions. Since this reaction progress asymptomatically, all cases of
MOM THA should be assessed periodically using CAT scan or MRI.
eP1-318 A SIMPLE SOLUTION FOR A RARE VASCULAR COMPLICATION FOLLOWING HIP
ARTHROPLASTY
Sá Rodrigues A, Dopico C, Seara M, Mateus A, Pinto I,
Freitas J, Pinto R
Hospital Sao João, Porto, Portugal
Introduction/objectives: Total hip arthroplasty (THA) has a low
complication rate and the incidence of vascular injury is even lower. We present a
case of an acetabular screw that resulted in injury and compression of left external
iliac artery and ischemia of the left lower limb.
Methods: A 70-year-old woman attended the emergency clinic for
evaluation of an increasing swollen left lower limb since she had woken up with
associated abdominal and left lower limb pain. She had an acetabular revision
surgery 3 months before she came to our emergency service due to aseptic acetabular
loosening. Pelvic CT scan showed a bulky hematoma nearby left iliopsoas leading to
an almost complete occlusion of the iliofemoral vascular bundle. She was immediately
proposed to surgery by vascular surgeons due to a bleeding artery combined with a
compressive hematoma.
Results: After the hematoma drainage, it was noticed that an acetabular
screw was in a close relationship with the left external iliac artery. Given the
emergency of the surgery, we simply cut the prominent screw with a bar cut usually
used in spine surgeries so the screw could be in the inner cortical boundary of the
acetabulum. Vascular surgeons arranged to repair the artery with no need of a
bypass. Post-op underwent well with improvement of edema and pain. A year later, the
patient has adequate vascularity and good ambulation assisted by a crutch with the
prosthesis remaining in the previous orientation.
Conclusions: We showed an unusual presentation of a late perforation of
a left external iliac artery due to an acetabular screw without loosening of
acetabular components. The issue was resolved by simply cutting part of the screw
avoiding other surgical options that should be much more aggressive for the
patient.
eP1-428 EVALUATION OF THE FIXATION OF THE TRABECULAR METAL WEDGE IN PATIENTS
UNDERGOING REVISION OF TOTAL HIP ARTHROPLASTY
de Sandes Kimura O, Freitas E, Linhares Garcia PB,
Leal DDC, Cury Fernandes MB
Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, Brazil
Introduction/objectives: This study evaluates the fixation of the
trabecular metal wedge in patients undergoing revision of total hip
arthroplasty.
Methods: Twenty-three cases with minimum grading of Paprosky II-B that
were operated between July 2008 and February 2013 were evaluated. These cases were
evaluated based on radiographs before the operation, immediately after the operation
and later on after the operation. Loss of fixation was defined as a change in the
abduction angle of the component greater than 10 degrees or any mobilization greater
than 6 mm.
Results: It was found that there was 100% fixation of the acetabula
after a mean of 29.5 months. One case underwent removal of the implanted components
due to infection.
Conclusions: There is still no consensus regarding the best option for
reconstructing hips with bone loss. However, revision using a trabecular metal wedge
has presented excellent short and medium-term results. This qualifies it as an
important tool for achieving a fixed and stable acetabular component.
eP1-48 BIPOLAR ARTHROPLASTY FOR THE TREATMENT OF UNSTABLE INTERTROCHANTERIC
FRACTURES, IS IT A GOOD OPTION?
Savadkoohi D, Siavashi B, Pendar E, Aalirezaei
A
Tehran University of Medical Sciences, Sina Hospital, Tehran, Islamic Republic of
Iran
Introduction/objectives: Arthroplasty for intertrochanteric fractures in
elderly patients allow early weight bearing and avoid fixation failure.
Methods: Clinical results are reviewed in a consecutive group of
unstable intertrochanteric fractures treated with acute cementless long stem bipolar
arthroplasties performed via direct lateral approach.
Results: 54 patients from 2010 to 2015 were studied. Average age was
72.4 years. Follow-up averaged 20 months. Four hips, required subsequent surgeries:
two for dislocation and one for sepsis and one for periprosthetic fracture.
Dislocation is higher than in primary total hip arthroplasty utilizing the same
surgical approach. There were 4 mortalities in follow up.
Conclusions: The results do not support routine use of arthroplasty in
treatment of intertrochanteric hip fractures because of high complication rates
(14.5%).
eP1-49 SUBTROCHANTERIC FRACTURES: COMPARISON OF DYNAMIC COMPRESSION SCREW
(DCS) AND INTRAMEDULLARY NAIL FIXATION OUTCOMES
Savadkoohi D, Siavashi B, Pendar E, Aalirezaei
A
Tehran University of Medical Sciences, Sina Hospital, Tehran, Islamic Republic of
Iran
Introduction: Fixation of subtrochanteric fractures is a challenge. This
study is for comparison of results of two types of fixation methods, Intramedullary
nailing and Dynamic compassion screw.
Materials and methods: This is a prospective study. All subtrochanteric
fractures entered this study. They are randomly fixed with Intramedullary or Dynamic
compression screw and their results and complications were evaluated.
Results: There were 21 patients in each group. Demographic parameters of
two groups were the same. Although malunion was more common in DCS group, but it was
not significant statistically. Post-operative results and complications were the
same as each other.
Conclusions: Both devices can be used with same results in treatment of
subtrochanteric fractures.
eP1-406 TOTAL HIP REPLACEMENT FOR FRACTURE NECK OF FEMUR
Thimmaiah R, Mehra A
Alexandra Hospital, Redditch, UK
Introduction/objectives: The annual incidence of hip fractures in the UK
is approximately 75,000, and cost £2 billion annually. According to the National
Institute for Health and Care Excellence guidance, surgery should be performed on
the day of, or day after admission which is also one of the criteria for best
practice tariff. The main objective was to evaluate the management of patients
undergoing total hip replacement (THR) for fracture neck of femur (NOF), and to
assess the impact of delay in operation on clinical outcome.
Methods: A retrospective audit was carried out, and all patients who
underwent THR for fracture NOF between September 2013 to September 2015 were
included. Data was collected using electronic case notes and audit proforma.
Results: A total of 46 patients underwent THR. The average age was 72
years (50-88). There were 19 male and 27 female patients. The left side was operated
in 25 patients. 31 patients had cemented, 10 had hybrid and 5 had un-cemented THR
respectively. With regards to ASA grade, 5 were grade 1, 23 were grade 2, and 17
were grade 3. There was an average delay of 5 days (1-35) in 25 of 46 patients. All
patients were discharged at an average of 11 days (3-29). 38 patients (20 in the
delayed group) had a last follow up at an average of 229 days (29-822). Only 2
patients in the delayed group and 1 in the non-delayed group complained of mild
pain. There were 5 deaths in total (10.8%).
Conclusions: More than half of the patients had a delay in having a THR
for fracture NOF. Although at follow up, those who had a delay had an outcome
comparable with those who did not have a delay, there is a financial impact in terms
of losing out on the best practice tariff and also on extended inpatient stays.
eP1-285 NERVE GROWTH FACTOR AFFECTS CHARACTERISTICS OF SENSORY INNERVATION AND
SYNOVIA OF THE HIP IN RAT
Omae T
Department of Orthopaedic Surgery, Teikyo University Chiba Medical Center, Chiba,
Japan
Introduction/objectives: Nerve growth factor (NGF) is a promising
analgesic target in patients with osteoarthritis (OA).
To determine the direct effects of intra-articular injection of NGF into normal rat
hips and the time course of pain-related mediator appearance, focusing particularly
on both inflammatory and neuropathic pain-related states using local tissues and
sensory innervation of the peripheral nervous system including the dorsal root
ganglion (DRG).
The purpose of this study was to clarify characteristics of histology and sensory
innervation in rat NGF model.
Methods: We used 36 eight-week-old male Sprague-Dawley rats weighing 250
g to 300 g.
Using a needle, 30 μl of 1% Fluoro-Gold solution (FG); (Sham-operated group; n = 12),
30 μl of 1% FG with 50 μ g/ml NGF; (NGF50 group; n = 12), and 30 μl of 1% FG with
100 μ g/ml NGF; (NGF100 group; n = 12) were injected into the left hip joints.
Histological examination of haematoxylin and eosin stain was performed on the synovia
in the hip joint.
The number of FG-labelled neurons and those with FG-labelling and calcitonin
gene-related peptide-immunoreactivity (CGRP-IR) were counted.
Results: The NGF groups showed evidence of synovitis compared with the
Sham-operated group.
At 7 days, the proportions of CGRP-IR FG-labelled to total FG-labelled neurons were
12%, 18%, and 36% in the Sham- operated, NGF50, and NGF100 groups, respectively.
At 14 days, the proportions were 13%, 22% and 35% in the Sham-operated, NGF50, and
NGF100 groups, respectively.
At 7 and 14 days, the NGF50 and NGF100 groups showed a significantly higher
proportion of CGRP-IR FG-labelled neurons than the Sham-operated group.
Conclusions: The NGF elicits synovitis and expression of CGRP in sensory
nerves. Our findings suggest that NGF is involved in hip joint pain
transmission.
eP1-274 MATHEMATICAL MODELING OF POWER DISTRIBUTION AND LOAD THEM ON THE VERGE
OF CONTACT POINTS BETWEEN FEMORAL COMPONENT OF THE HIP PROSTESIS AND THE
FEMUR
1Institute of Traumatology and Orthopaedics, Kyiv, Ukraine;
2Kyiv National University n.a. T. Shevchenko, Kyiv, Ukraine
Introduction/objectives: The methods of mathematical modelling point
load distribution of forces and their moments for stem of hip prostesis were
elaborated. Such modelling is essential for the analysis of the process of
pathological changes in the hip joint and early surgical intervention to restore
normal exposure and normal functioning of the implant.
Methods: Region of perfect contact between stem and bone in a simulated
hyperboloid of revolution, which is the closest geometrical shape of this
prosthesis. The main focus of the study was focused on the calculation and analysis
of the relationship between the elastic forces of load length leg prosthesis in
idealized conditions.
Results: The work conducted mathematical modelling distribution point
loading forces and their moments in the dense and defect-free (ideal) surface
contact between the stem and the femur. It is necessary, as a test for the future,
in the modelling of pathological deviations in the distribution of forces and
moments caused by disturbances in various areas Gruen according to the
classification Paproski. It is shown that idealized conditions, both components of
the distribution of the elastic force loads are expected dependence on the spatial
variable and the length of the stem. Found that in ideal conditions (dense and
defect-free contact) time point total power load is zero.
Conclusions: The emergence of deviations, including pathological, the
density of contact between the prosthesis and bone will lead to changes in the
distribution of power in comparison with the test and the appearance is not
compensated total since these forces.
eP1-304 A NOVEL TAPERED WEDGE STEM: MULTI-CENTER CLINICAL OUTCOMES
STUDY
Sharpe K1, Cohen R2, Campbell D3
1OrthoArizona, Mezona Orthopaedic, Gilbert, United States;
2Tucson Orthopaedic Institute, Tucson, USA; 3Stryker
Orthopaedics, Mahwah, USA
Introduction/objectives: Cementless tapered wedge stems have shown
excellent results over the last decade. Distal potting with inadequate proximal fit,
as well as failure to achieve biologic fixation has led to thigh pain, loosening and
implant failure. A novel tapered wedge stem was designed with reduced distal
morphology, maximizing the proximal contact of the grit blasted ongrowth surface.
The objective of the study was to analyze the clinical outcomes of this stem
design.
Methods: Three hundred and nineteen patients enrolled into prospective,
multicenter studies received a tapered wedge stem. Clinical and patient-reported
outcomes were evaluated.
Results: Demographics of the study population include 53.3% male
patients with a mean age of 62.4±9.3 years and BMI of 29.8±4.5. To date, there has
been 1 incidence of thigh pain (0.3%) and a 0.63% aseptic revision rate.
Kaplan-Meier survivorship analysis for the population at 2 years estimated 97.87%
with 95% CI (93.98% - 99.25%) survivorship to all cause revision. Statistically
significant improvements in function and quality of life were seen at 6 weeks
postoperative and continued through 2 years in the HHS and EQ-5D TTO evaluation,
increasing by 42 points and 0.3 at 2 years, respectively. Additionally, clinically
relevant increases were seen in the SF-12 and LEAS at 1 year postoperative.
Conclusion: A novel tapered wedge stem was designed to maximize proximal
fit medially and laterally across a variety of patient morphologies. Radio-graphic
studies have shown the stem design has significantly better canal fit compared to
older tapered wedge designs. The current study exhibits low incidence of thigh pain
and revisions, with improvements in function, pain and quality of life after hip
arthroplasty with this tapered wedge stem.
