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PubMed2026

Arthroscopic Correction of Pincer-Type FAI in the Presence of Acetabular Retroversion Results in Excellent Patient-Reported Outcomes With Low Risk of Reoperation or Conversion to Arthroplasty at Minimum 5 Years.

BACKGROUND: Acetabular retroversion is a distinct morphologic variation that may result in pincer-type femoroacetabular impingement (FAI). The role of arthroscopic management within this cohort is not fully understood. PURPOSE: To assess patient-reported outcome measures (PROMs) and survivorship at 5-year follow-up in a series of cases undergoing arthroscopic correction of pincer-type FAI with acetabular retroversion. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A single-center, prospective hip preservation registry was reviewed for all cases undergoing primary hip arthroscopy for symptomatic FAI between January 2014 and July 2020, with documented radiographic assessment of acetabular retroversion (ie, presence or absence of crossover sign, ischial spine sign, and/or posterior wall sign on a standing, standardized anteroposterior radiograph). Exclusion criteria were Tönnis grade >1, concomitant pathologies (protrusio, Perthes disease, avascular necrosis), excessive pelvic rotation or tilt on radiographs, and/or no crossover sign. Cases were assigned to 1 of 2 groups: moderate-global retroversion group (study group: crossover sign plus either or both ischial spine sign and posterior wall sign) or control group (crossover sign only). Case-control (1:1) fuzzy matching was performed based on age (±2 years), sex, and Tönnis grade (exact). Clinical outcome evaluation included assessment of PROMs (modified Harris Hip Score [mHHS], 36-item Short Form [SF36], University of California-Los Angeles Activity Scale [UCLA], Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), achievement of Patient Acceptable Symptom State (PASS), satisfaction, rates of revision arthroscopy, and arthroplasty-free survivorship, both preoperatively and 5 years postoperatively. Statistical analysis was performed using SPSS v29. RESULTS: A total of 201 cases (120 global, 81 moderate) in the moderate-global retroversion group were matched with 201 control cases. Mean age was 30.6 ± 10.2 years; the sample was 90% male. The rate of revision arthroscopy was similar: n = 11 (6%) in both groups (P = .974). No conversion to periacetabular osteotomy (PAO) occurred in either group. Arthroplasty-free survivorship was 98.2% (retroversion group) and 98.8% (control group) (χ2 = 0.189; df = 1; P = .664). Significant improvements in PROMs from baseline were noted (P < .001 for all, in both groups). In total, 81% (moderate-global retroversion group) and 73% (control group) were satisfied at 5 years (P = .103). No significant difference was seen in PASS achievement rates for any of the PROMs between groups: mHHS, 62.1% versus 65.9% (P = .498); UCLA, 60.0% versus 52.2% (P = .192); SF36, 59.8% versus 64.7% (P = .458); WOMAC, 63.5% versus 67.3% (P = .553), for moderate-global retroversion and control groups, respectively. CONCLUSION: Hip arthroscopy for moderate and global acetabular retroversion resulted in significant improvement in clinical outcomes, with high satisfaction and arthroplasty-free survivorship at 5 years, consistent with a case-control matched group without acetabular retroversion (focal retroversion, pincer FAI). Arthroscopy alone, without anteverting PAO, was an effective surgical management approach for symptomatic FAI in the presence of acetabular retroversion.

Humans↗

PubMed2003

Perioperative complications of total ankle arthroplasty.

A retrospective radiographic and chart review was performed for the initial 50 patients who underwent Agility (DePuy, Warsaw IN) total ankle arthroplasty by the senior author (M.S.M.). The review focused on the perioperative complications of nerve or tendon lacerations, intraoperative fractures, acute deep infections, wound complications and component positioning. Major wound complications were defined as those requiring a soft-tissue coverage procedure. Minor wound complications did not require soft tissue coverage and included wound breakdowns, wound edge necrosis, and superficial infections. The immediate mortise and lateral postoperative radiographs were reviewed to measure component positioning. The patients were divided into two groups to compare the initial 25 patients (Group A) with the subsequent 25 patients (Group B). There were no major wound complications in either group. Minor wound complications decreased from six in Group A to two in Group B. There were four lacerations (flexor hallucis longus, posterior tibial tendon, deep peroneal nerve, and superficial peroneal nerve), all occurring in Group A. Five patients sustained intraoperative fractures in Group A, as compared with two fractures in Group B. The number of components varying greater than 4 degrees from neutral as measured by the lateral talar, lateral tibial and mortise tibial component angles decreased by 9% from Group A to Group B. The only tibial component to be placed in more than 4 degrees of valgus occurred in Group A. It seems that a notable learning curve exists in the performance of total ankle arthroplasty as demonstrated by a comparison of the initial 25 patients with the subsequent 25 patients performed by one orthopaedic surgeon. This improvement most likely resulted from the use of enhanced techniques and further training with the prosthesis. This information can be used as a teaching tool to decrease the incidence of complications for surgeons performing their initial arthroplasties with this potentially technically demanding procedure.

Adult↗

PubMed2004

Bone mineral density, gait analysis, and patient satisfaction, before and after ankle arthroplasty.

Bone mineral density (BMD) and patient satisfaction were measured and gait analysis was performed in patients treated with unilateral dual-coated ankle arthroplasty. The study comprised 14 patients (eight women and six men) measured preoperatively and at a median of 15 (range, 12-26) months after surgery. BMD was measured bilaterally in the distal tibia and in the calcaneus. A plantar pressure analysis was performed, including foot contact duration and a new index for describing the ground reaction force curve called the Valley Index (VI). The patients also evaluated their level of pain, ability to cope with daily activities, adaptation of shoes, and walking ability before surgery and at follow-up on a visual analogue scale (VAS). Bone mass significantly increased adjacent to the tibial part of the prosthesis. The patients experienced less pain and improved walking and performance in daily activities. There was also a decrease in foot contact duration as well as an increase in VI and ankle range of motion. Change in bone mass was the variable that correlated best with the patients' evaluation of the general outcome of ankle arthroplasty. Correlations among other variables are described. The study concluded that a fairly simple analysis of the ground reaction force curve, bone mass measurements, and VAS can demonstrate that ankle arthroplasty is able to normalize gait, decrease foot contact duration, increase bone mass, and reduce pain.

Adult↗

PubMed2004

Usefulness of bioabsorbable thread pins after resection arthroplasty for rheumatoid forefoot reconstruction.

BACKGROUND: Bioabsorbable thread pin has been used for internal fixation of bone. The results of resection arthroplasty of the lesser metatarsophalangeal (MTP) joints using internal intramedullary fixation with bioabsorbable pins have not been reported. METHODS: Resection arthroplasty of the MTP joints of the lesser toes with poly-L-lactic acid (PLLA) thread pins or Kirschner wires was performed at random in reconstruction of the 87 rheumatoid forefeet (62 patients) with a grommet-protected silicone-rubber implant insertion of the first MTP joint. Clinical symptoms, the state of radiographic changes, and complications were assessed 5-10 years (average, 7.7 years) postoperatively. RESULTS: The mean American Orthopaedic Foot and Ankle Society clinical scores at the preoperative and latest points were 31 and 91, respectively, in the operated patients with PLLA pins, while the mean scores were 32 and 82, respectively, in the operated patients with Kirschner wires. The lesser toes treated by bioabsorbable pins did not become rigid, although they were stable. Recurrent dorsal subluxation of the lesser MTP joints was visible on radiographs in three of the 46 feet with PLLA pins, while two feet had three dislocated MTP joints and one subluxated MTP joint postoperatively and recurrent dorsal subluxation of the lesser MTP joints was visible in four of the 41 feet with Kirschner wires. The postoperative hallux valgus did not progress to the preoperative level during the follow-up period in both groups. Two of the 46 feet with PLLA pins and two of the 41 feet with Kirschner wires had radiographic evidence of silicone synovitis without pathological fracture. Three patients with Kirschner wires had wire-track infection, and one patient had severe circulation disturbance of the corrected lesser toes necessitating wire removal. CONCLUSIONS: A new trial of internal fixation with bioabsorbable pins may lead to the establishment of a safe method for enhancing stability of the lesser toes after resection arthroplasty of the lesser MTP joints.

Absorbable Implants↗

PubMed1997

Roger Mann Award 1995. Capsular interposition arthroplasty for severe hallux rigidus.

Thirty patients (37 feet) with severe hallux rigidus underwent resection arthroplasty of the first metatarsophalangeal joint with our modification (reattachment of the extensor hood and extensor brevis to the flexor hallucis brevis as a capsular interposition arthroplasty, with minimal bone resection). Pain and function were significantly improved. Transfer metatarsalgia was not seen. All patients had at least 4/5 plantarflexion strength and averaged 50 degrees of dorsiflexion. In patients with severe hallux rigidus and nearly equal length of first and second metatarsals, capsular interposition arthroplasty offers a surgical option that relieves pain without sacrificing motion or strength.

Arthroplasty↗

PubMed2003

Pedicled gastrocnemius flap in complicated total knee arthroplasty.

BACKGROUND AND AIMS: The aim of this study was to evaluate the results of complicated total knee arthroplasty operations treated with radical wound revision and a pedicled gastrocnemius muscle flap. MATERIAL AND METHODS: Retrospective analysis in a university hospital during a five-year-period. RESULTS: Wound revision, debridement of the knee joint, replacing tibial plastics and a unilateral pedicled gastrocnemius muscle flap operation was performed to 10 patients after complicated total knee arthroplasty. After a median follow up time of 11.5 months 8/10 total knee arthroplasty joints were saved. CONCLUSIONS: As much as 80% of patients could save their knee joint with this treatment protocol. Treatment of this problem needs good collaboration with orthopaedic and plastic surgeons.

Aged↗

PubMed2005

Albumin induced hypercoagulability does not reduce blood loss in patients undergoing total hip arthroplasty.

BACKGROUND AND AIMS: Albumin may enhance and hydroxyethyl starch (HES) may impair haemostasis. While the effects are also dependent on haemodilution we minimized it by early structured transfusion therapy, and compared albumin and HES regarding blood loss and coagulation parameters in hip arthroplasty patients. MATERIAL AND METHODS: 101 patients undergoing primary hip arthroplasty received in random order 4% albumin (n = 48) or HES (average Mw 120 kDa/molar substitution ratio 0.7, n = 53). The administration of colloid, red blood cell (RBC), fresh frozen plasma and platetet concentrates begun after a 6-8%, 12-16%, 60% and 100% blood loss of the patient's calculated blood volume respectively. Explanatory risk factors for blood loss were modelled by regression analysis. RESULTS AND CONCLUSIONS: Administration of albumin or HES 1200 ml (500-2000 and 500-1800) [median (range) respectively] did not affect blood loss. The vWF antigen was higher in the albumin group (p = 0.04) postoperatively. Haematocrit value, platelet count, bleeding time, prothrombin time value, activated thromboplastin time, FV activity and fibrinogen concentration were comparable between the groups. Long operation time was associated with great blood loss (p < 0.001). In hip arthroplasty patients with near normal levels of haematocrit albumin enhanced coagulation without altering blood loss.

Adult↗

PubMed2002

Total hip arthroplasty for arthrodesed hips.

The benefits of converting an ankylosed or arthrodesed hip to total hip arthroplasty have been reported in the literature as have the technical difficulties associated with this procedure. This review, however, outlines the experience of a single surgeon (WJMB) at a single institution using uncemented prostheses. Between November 1991 and June 1996, 5 arthrodesed hips underwent uncemented total hip arthroplasty in 4 males and 1 female. Clinical and radiological follow-up review was for at least three years in all patients. In general, patients were satisfied with the outcome of their surgery with Harris Hip scores improving from an average of 62 preoperatively to an average of 72 postoperatively. The surgical outcome in these difficult cases was not as satisfactory as for routine total hip arthroplasty. Meticulous preoperative planning is required to aim toward leg length restoration and restoration of the abductor moment arm. A modular prosthesis allows versatility at surgery.

Adult↗

PubMed2002

Salvaging unstable or recurrent dislocating total hip arthroplasty with the constrained acetabular component.

PURPOSE: To review cases of implantation of constraining acetabular components for unstable or recurrent dislocating total hip arthroplasty at the Department of Orthopaedics, Concord Hospital, Sydney. METHODS: A retrospective analysis was performed on prospectively collected data of 13 consecutively enrolled patients. RESULTS: From 1989 to 2000, 13 constraining acetabular components were implanted into 13 patients as a revision procedure. The surgical approach for the implantation of the constrained liner was posterolateral in 11 cases; a modified Hardinge approach was applied in 2 cases. The mean clinical follow-up duration was 43 months (range, 14-121 months) and the mean age at the time of surgery was 73 years (range, 52-84 years). No patients were lost to follow-up. Indications for using the constrained acetabular component were recurrent dislocation in revision hip replacements (n=8), and intra-operative instability (n=5). There were no episodes of dislocation of the constrained arthroplasty. In 7 cases, the constrained component was implanted into a previously well-fixed shell. CONCLUSION: We recommend the judicious use of the constrained component in cases of hip instability during or after total hip arthroplasty when other methods are not successful.

Acetabulum↗

PubMed2003

The incidence of proximal deep vein thrombosis following total knee arthroplasty in an Asian population: a Doppler ultrasound study.

PURPOSE: To investigate the incidence of deep vein thrombosis (DVT) following total knee arthroplasty in an Asian population. METHODS: A prospective study of 149 consecutive cases of total knee arthroplasty done for osteoarthritis was conducted over a 5-year period. All patients underwent duplex ultrasonographic assessment of the lower limbs within the first postoperative week. RESULTS: The incidence of proximal DVT was found to be 4.38% in this study. Symptomology was statistically significant in predicting the presence of proximal DVT in all cases. General anaesthesia was associated with a statistically significant-higher incidence of DVT as compared with regional anaesthesia. There was a significant association between a sedentary lifestyle and the development of DVT. CONCLUSION: The incidence of proximal DVT in Asian patients after total knee arthroplasty is higher than that previously reported for this demographic group.

Adult↗

PubMed2004

Cementless total hip arthroplasty using an autograft of the femoral head for marked acetabular dysplasia: case series.

PURPOSE: To assess the short-term outcome of cementless total hip arthroplasty involving an autograft of the femoral head in Japanese patients. METHODS: Cementless total hip arthroplasty with autogenous bone block grafting was performed on 18 hips in 15 patients with marked acetabular dysplasia. The resected femoral head was used as a graft for the superior-lateral region of the true acetabulum. Clinical outcome was correlated with the placement of the acetabular component, as revealed in radiographs. RESULTS: The 13 women and 2 men had a mean age of 60.2 years (range, 37.0-73.0 years) at primary surgery and a mean follow-up duration of 3.3 years (range, 2.0-5.3 years). According to the classification of Crowe, 4 hips were in group I, 3 were in group II, one in group III, and 10 in group IV. The mean Harris Hip Score preoperatively was 45.7 (range, 19-69) and that at follow-up was 82.5 (range, 44-100). All 15 cases showed a good clinical outcome. There were no major intra-operative complications in this series. The grafted bones united in all patients. Two patients need surgical revision because the lateral insertion of the acetabular component resulted in loosening of it. CONCLUSION: Medial insertion of the acetabular component provides satisfactory short-term outcomes. Lateral insertion of the acetabular component during total hip arthroplasty should be avoided in patients with marked acetabular dysplasia.

Acetabulum↗

PubMed2004

Revision of total hip arthroplasty using an anterior cortical window, extensive strut allografts, and an impaction graft: follow-up study.

PURPOSE: To report the outcome of revised total hip arthroplasty procedures involving an anterior cortical window, extensive strut allografts, and an Exeter impaction graft. METHOD: Eight patients (9 hips) with a mean age of 58 years underwent revision of total hip arthroplasty using the Exeter hip impaction graft system and strut allografts between 1995 and 1998. An extensile anterior approach was used, and an anterior cortical window was created in the femur, to remove the old implant. External strut allografts were attached by wires to provide cortical support. The mean follow-up duration was 74 months. Indications for surgery were aseptic loosening of previous implants in 8 hips and infection of one hip that had previously undergone total arthroplasty. RESULTS: 19 Dall Miles cables, 4 ordinary cerclage wires, and 8 cerclage wires tightened with the clincher knot technique were used to secure the allograft to the host bone. The strut grafts were found to be incorporated in all cases. No wires became loose. One patient developed 20 degrees of angulation at the allograft-host bone junction. Using the method of Fowler and Gie, we found that one femoral implant had subsided 2 mm within the cement mantle. Two other implants had 1 mm of subsidence at the cement bone interface, and one patient had a major subsidence of 15 mm that required revision. CONCLUSION: Using an anterior cortical window in the femur to remove the old implant does not predispose to failure of the allograft to incorporate into the host bone.

Adult↗

PubMed2004

Deep vein thrombosis after total hip arthroplasty in Indian patients with and without enoxaparin.

PURPOSE: To study the incidence of deep vein thrombosis in Indian patients undergoing total hip arthroplasty with or without prophylaxis, and the effect of enoxaparin on deep vein thrombosis. METHODS: The study covered a total of 50 hips in 40 patients who underwent total hip arthroplasty. Patients were assessed for deep vein thrombosis using Doppler ultrasonography. The hips were numbered and divided into 2 groups: the odd-numbered hips did not receive any thrombo-prophylaxis, whereas the even-numbered hips received 40 mg of enoxaparin subcutaneously, once a day for 2 weeks, until the time of discharge. RESULTS: Deep vein thrombosis was not found in both groups. We found wound haematomas in 9 patients (all of whom were on enoxaparin) (p<0.05), superficial infection in 2 patients (one on enoxaparin, one not), and local bruising in 4 patients (all of whom were on enoxaparin). Major haemorrhage did not occur in any of the cases. CONCLUSION: The incidence of deep vein thrombosis in Indian patients is very low compared to that in European and American patients. Enoxaparin failed to provide any advantage to the patients. It is therefore not advisable to give prophylaxis/low-molecular-weight heparin for deep vein thrombosis to patients undergoing total hip arthroplasty without any risk factors.

Adult↗

PubMed2005

Investigation of the use of drained blood reinfusion after total knee arthroplasty: a prospective randomised controlled study.

PURPOSE: To compare the use of a blood salvage and reinfusion system with standard allogeneic blood transfusion after total knee arthroplasty--a procedure associated with significant postoperative blood loss. METHODS: Between June 2002 and May 2004, 60 patients undergoing total knee arthroplasty were randomly allocated into a reinfusion group (n = 26) or a control group (n = 34). Patients in the reinfusion group had their blood reinfused from drains within 6 hours of surgery. Both groups received allogeneic blood transfusions according to specified transfusion criteria if the haemoglobin level fell below 90 g/l, or in the presence of severe anaemic symptoms. Haemoglobin levels and drain output were recorded daily for 3 consecutive days after surgery. RESULTS: There was no significant difference between the 2 groups in demographic data, drain output, total blood loss, and mean postoperative haemoglobin levels. Significantly more allogeneic blood was required by the control group than by the reinfusion group (p = 0.022). CONCLUSION: Postoperative reinfusion of drained blood reduced the need for blood transfusion after total knee arthroplasty, while having an effect on postoperative haemoglobin level equivalent to standard allogeneic blood transfusion.

Aged↗

PubMed2006

Total hip arthroplasty infected by Brucella: a report of two cases.

Infection caused by Brucella following total joint arthroplasty is very rare. We present 2 cases of brucellar infection following total hip arthroplasty (THA). A 66-year-old woman who had prolonged contact with cattle presented with pain at the thigh and groin areas. The patient had undergone an uncemented THA for a hip fracture 3 years previously. Cultures of articular liquid were positive for Brucella abortus. The implant was loosened and was managed with a 2-stage re-implantation. A 71-year-old man presented with painless suppuration of the hip joint through the scar from previous surgeries. Radiography demonstrated a well-integrated THA. When postoperative cultures were found positive for Brucella melitensis, antibiotic treatment of rifampicin 900 mg, streptomycin 1 g, and doxycycline 200 mg daily were prescribed. At 5.5-year and 5-year follow-up, respectively, both patients were asymptomatic and free of infection with well-integrated implants. As the Brucella pathogen is highly susceptible to antibiotics, standard 2-stage revision arthroplasty for loosened implant or debridement and antibiotic treatment for well-fixed implant should suffice.

Aged↗

PubMed1976

Excision arthroplasty of the elbow in rheumatoid disease.

The results of ten excision arthroplasties of the elbow for rheumatoid disease are described. The operation may afford good relief of pain and a useful increase both of hinge motion and of forearm rotation. Instability is not a serious problem unless the patient has to bear weight on crutches. To increase stability after arthroplasty it appears that Kirschner wire fixation is advisable as well as a plaster cast. For advanced rheumatoid disease unilateral excision arthroplasty has a definite value, especially for patients confined to a wheelchair.

Adult↗

PubMed1998

Fixation of the tibial component of total knee arthroplasty after high tibial osteotomy: a matched radiostereometric study.

To assess migration of the tibial component we used roentgen stereophotogrammetric analysis in 40 patients who had had a total knee arthroplasty after failure of a closing wedge osteotomy and compared them with 40 matched patients after primary total knee arthroplasty. We found no difference in migration over time or in the tendency for continuous migration between the two groups. There were no differences in alignment or position of the knee prosthesis or in the clinical outcome. Our findings show that revision of a failed high tibial osteotomy to a total knee arthroplasty is effective.

Aged↗

PubMed2000

Treatment of the mobile, painful arthritic elbow by distraction interposition arthroplasty.

Between 1986 and 1994, 13 patients with mobile painful arthritic elbows were treated by distraction interposition arthroplasty using fascia lata. The mean period of follow-up was 63 months. An elbow distractor/fixator was applied for three to four weeks to separate the articular surfaces and to protect the fascial graft. Nine of the 13 patients (69%) had satisfactory relief from pain; eight (62%) had an excellent or good result by the objective criteria of the Mayo Elbow Performance score. Four have required revision to total elbow arthroplasty at a mean of 30 months with good results to date. Instability of the elbow, both before and after surgery, was found to be associated with unsatisfactory results. The rate of success when the procedure was performed for inflammatory arthritis was similar to that for post-traumatic arthritis, about 67%. Eight complications occurred in six patients, all in the group with post-traumatic arthritis. Two of these required further surgical procedures such as transposition of the ulnar nerve or repair of hernia of the fascia lata. Although less reliable than prosthetic replacement, distraction interposition arthroplasty is a useful option in the treatment of young, high-demand patients with arthritis of the elbow. It is rarely indicated in the presence of generalised inflammatory arthritis, but may be of value in those patients in whom the disease is limited primarily to the elbow.

Adult↗