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AIMS: Adult patients with history of childhood infection pose a surgical challenge for total hip arthroplasty (THA) due to distorted bony anatomy, soft-tissue contractures, risk of reinfection, and relatively younger age. Therefore, the purpose of the present study was to determine clinical outcome, reinfection rate, and complications in patients with septic sequelae after THA. METHODS: A retrospective analysis was conducted of 91 cementless THAs (57 male and 34 female) performed between 2008 and 2017 in patients who had history of hip infection during childhood. Clinical outcome was measured using Harris Hip Score (HHS) and Modified Merle d'Aubigne and Postel (MAP) score, and quality of life (QOL) using 12-Item Short Form Health Survey Questionnaire (SF-12) components: Physical Component Score (PCS) and Mental Component Score (MCS); limb length discrepancy (LLD) and radiological assessment of the prosthesis was performed at the latest follow-up. Reinfection and revision surgery after THA for any reason was documented. RESULTS: There was significant improvement in HHS, Modified Merle d'Aubigne Postel hip score, and QOL index SF 12-PCS and MCS (p < 0.001) and there was no case of reinfection reported during the follow-up. The minimum follow-up for the study was three years with a mean of 6.5 (SD 2.3; 3 to 12). LLD decreased from a mean of 3.3 cm (SD 1) to 0.9 cm (SD 0.8) during follow-up. One patient required revision surgery for femoral component loosening. Kaplan-Meier survival analysis estimated revision-free survivorship of 100% at the end of five years and 96.9% (95% confidence interval 79.8 to 99.6) at the end of ten years. CONCLUSION: We found that cementless THA results in good to excellent functional outcomes in patients with a prior history of childhood infection. There is an exceedingly low rate of risk of reinfection in these patients, even though complications are not uncommon. Cite this article: Bone Jt Open 2022;3(4):314-320.
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Aim: Evaluate the validity of a recent approach to calculate the knee flexion or extension contracture contributing to the overall sagittal deformity using the sagittal mechanical axis angle (SMAA) for the overall alignment assessment and sagittal joint line angle (SJLA) for soft tissue contribution. The methods of evaluating these angles and their clinical applications are discussed. Materials and methods: In total, 107 normal limbs met the criteria and were divided into two groups: skeletally mature and immature. Sagittal alignment was evaluated using the Bone Ninja iPad application, and the posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA), SMAA and SJLA were recorded. Results: In skeletally immature patients, mean SJLA was 13.46° [standard deviation (SD), 4.55°], and in mature patients, it was 16.91° (SD, 2.948°). The PDFA and PPTA were consistent with previously published measurements. Conclusion: The SJLA method is a practical way to quantify the soft tissue contribution and degree of contracture. It can also be used for monitoring deterioration or improvement of knee range of motion during lengthening or physical therapy. Clinical significance: All patients in this study presented to our clinic with symptoms on the contralateral side. This, in addition to the retrospective nature, was a limitation in our study.We recommend a validity study to compare our SJLA method to the classic anterior cortical line angle (ACL) method in addition to an inter-observer and intra-observer reliability study for the SJLA. We also recommend a study on completely normal asymptomatic subjects to better standardise the angle measurements in skeletally immature patients at different ages. How to cite this article: Abalkhail TB, McClure PK. Sagittal Plane Assessment in Deformity Correction Planning: The Sagittal Joint Line Angle. Strategies Trauma Limb Reconstr 2022;17(3):159-164.
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AIMS: Total hip arthroplasty (THA) in patients with post-polio residual paralysis (PPRP) is challenging. Despite relief in pain after THA, pre-existing muscle imbalance and altered gait may cause persistence of difficulty in walking. The associated soft tissue contractures not only imbalances the pelvis, but also poses the risk of dislocation, accelerated polyethylene liner wear, and early loosening. METHODS: In all, ten hips in ten patients with PPRP with fixed pelvic obliquity who underwent THA as per an algorithmic approach in two centres from January 2014 to March 2018 were followed-up for a minimum of two years (2 to 6). All patients required one or more additional soft tissue procedures in a pre-determined sequence to correct the pelvic obliquity. All were invited for the latest clinical and radiological assessment. RESULTS: The mean Harris Hip Score at the latest follow-up was 79.2 (68 to 90). There was significant improvement in the coronal pelvic obliquity from 16.6o (SD 7.9o) to 1.8o (SD 2.4o; p < 0.001). Radiographs of all ten hips showed stable prostheses with no signs of loosening or migration, regardless of whether paralytic or non-paralytic hip was replaced. No complications, including dislocation or infection related to the surgery, were observed in any patient. The subtrochanteric shortening osteotomy done in two patients had united by nine months. CONCLUSION: Simultaneous correction of soft tissue contractures is necessary for obtaining a stable hip with balanced pelvis while treating hip arthritis by THA in patients with PPRP and fixed pelvic obliquity. Cite this article: Bone Jt Open 2021;2(9):696-704.
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BACKGROUND: An equinus deformity interferes with activities of daily living. Correction of the deformity ranges from conservative (heel cord stretching, orthotics) to surgical treatment (Baumann, Strayer, Achilles lengthening, soft tissue releases). Severe contractures increase surgical intervention with extensive dissections to release soft tissues. This study investigated the clinical outcomes of gradual overcorrection using a Taylor spatial frame (TSF) with tendo-Achilles lengthening (TAL) added as necessary. MATERIALS AND METHODS: This retrospective chart review evaluated patients with significant equinus treated with a TSF at a single large tertiary referral centre. Data collected included: diagnosis; patient demographics; laterality; time in frame; additional procedures; complications; degree of equinus deformity preoperatively and at every follow-up visit. Patients were followed at 1 week, 3 weeks, 6 weeks, 3 months, and 6 months intervals, and yearly thereafter. RESULTS: Twenty-four patients (26 procedures) were treated with a TSF for equinus and had complete preoperative and follow-up measurements over 2 years. The angle of deformity increased from a preoperative -21.5 (range, -69.0 to -1.0) degrees to a postoperative 4.9 (range, -17.0 to 17.0) degrees (z = -4.4573, p = 0.0001, N = 26, Wilcoxon signed-rank test). A secondary outcome was a weak association (not statistically significant) between time in the TSF and the postoperative deformity angle. Four complications occurred during the follow-up (two pin site infections, one broken pin, and one plantar abscess). Three patients had recurrence of equinus deformity at time of last follow-up. CONCLUSION: Using a TSF for correcting severe, fixed equinus contractures of the ankle joint is successful with minimal soft tissue-related complications. Overcorrection should be achieved in order to compensate for the loss of some dorsiflexion after frame removal. No added benefit was observed from having the frame on for a long time after correcting the deformity. Adding TAL is not necessary in all cases and required only in severe deformities of more than 25°. HOW TO CITE THIS ARTICLE: Dabash S, Potter E, Catlett G, et al. Taylor Spatial Frame in Treatment of Equinus Deformity. Strategies Trauma Limb Reconstr 2020;15(1):28-33.