RESUMEN
This case report describes a woman in her 70s who presented with a 3-month history of hip pain and inability to walk. Upon admission, she was diagnosed with the extremely rare condition of complete femoral head disappearance. A comprehensive examination was conducted to determine the cause and devise an effective treatment strategy, taking the patient's medical history into account. Through interdisciplinary discussions, occult infection and other potential causes were ruled out. The femoral head disappearance was ultimately determined to be due to wear, ischemia, and absorption following a fracture. After informing the patient of the diagnosis and treatment plan, total hip arthroplasty was proposed. This case highlights the rarity and severity of femoral head disappearance in patients with femoral neck fractures, emphasizing the effectiveness of total hip arthroplasty and appropriate joint prostheses in managing such cases. This case has significant implications for clinical diagnosis, treatment, and complication prevention. The report also discusses the causes of acquired femoral head disappearance, relevant diagnostic assessments, and alternative treatment options.
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Artroplastia de Reemplazo de Cadera , Fracturas del Cuello Femoral , Cabeza Femoral , Humanos , Fracturas del Cuello Femoral/cirugía , Fracturas del Cuello Femoral/diagnóstico por imagen , Femenino , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/patología , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversosRESUMEN
CASE: A 48-year-old man presented to a Level 1 trauma center after a motor vehicle crash with a right irreducible posterior hip dislocation and ipsilateral fractures of the femoral head and segmental femur shaft. This injury was managed with open reduction and internal fixation and antegrade intramedullary nailing. CONCLUSION: This is the first report of a combined irreducible femoral head fracture-dislocation and a segmental femur fracture, a rare injury that requires a stepwise approach to operative management of each injury. Surgeons must recognize the clinical and radiographic findings associated with irreducible hip dislocations in the setting of ipsilateral fractures to the femoral head and shaft.
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Fracturas del Fémur , Humanos , Masculino , Persona de Mediana Edad , Fracturas del Fémur/cirugía , Fracturas del Fémur/diagnóstico por imagen , Luxación de la Cadera/cirugía , Luxación de la Cadera/diagnóstico por imagen , Accidentes de Tránsito , Cabeza Femoral/lesiones , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Fracturas de Cadera/cirugía , Fracturas de Cadera/diagnóstico por imagen , Fijación Interna de Fracturas/métodos , Fijación Intramedular de FracturasRESUMEN
Aseptic necrosis of the femoral head is one of the most important problems in traumatology, a complex disease in which there is a gradual deformation of the femoral head in the places where the greatest load is applied to it. The disease is the cause of disability in 7% of all orthopedic patients with lower limb dysfunction. There are various surgical and conservative approaches to the treatment of this pathology. This article provides an overview of the available data on the use of these methods for the correction of osteonecrosis of the hip joint.
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Necrosis de la Cabeza Femoral , Humanos , Necrosis de la Cabeza Femoral/terapia , Cabeza Femoral/patología , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagenRESUMEN
INTRODUCTION: Postoperative osteoarthritis (OA) progression is a major determinant of failure after curved periacetabular osteotomy (CPO). A large postoperative combination angle, i.e., the combination of computed tomography-based anterior center edge and alpha angles, is associated with femoroacetabular impingement after CPO, but its association with postoperative OA progression is unclear. We aimed to identify the anatomical parameters that can lead to OA progression after CPO and the impact of the combination angle on the same. MATERIALS AND METHODS: We included 90 hips that were subjected to CPO at our center between March 2013 and March 2018. Seventeen hips showed OA progression with an increase in the Tönnis classification after surgery; 73 hips showed no progression. Radiographic anatomical parameters, including the lateral and anterior center edge angles, femoral and acetabular anteversion, and combination angle, and clinical outcomes, including modified Harris Hip Scores (mHHSs), postoperative anterior impingement, and range of motion, were compared between the two groups. Statistical significance was set at P < 0.05. RESULTS: Postoperative OA progression was significantly affected by preoperative OA evidence (P = 0.017), acetabular anteversion < 5.0° (P = 0.003), and a combination angle > 107.0° (P = 0.025). Patients with radiographic OA progression were associated with poor mHHSs (P = 0.017) and high frequencies of anterior impingement with a limited hip flexion and internal rotation angle. CONCLUSIONS: OA progression after CPO may be associated with preoperative evidence of OA and postoperative acetabular retroversion as well as a large combination angle. Surgeons should focus on the potential effects of preoperative OA grades, postoperative reduction in acetabular anteversion, and postoperative combination angle.
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Acetábulo , Progresión de la Enfermedad , Cabeza Femoral , Osteoartritis de la Cadera , Osteotomía , Humanos , Masculino , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Femenino , Osteotomía/métodos , Adulto , Osteoartritis de la Cadera/cirugía , Osteoartritis de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/etiología , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Pinzamiento Femoroacetabular/cirugía , Pinzamiento Femoroacetabular/diagnóstico por imagen , Cuello Femoral/diagnóstico por imagen , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Persona de Mediana Edad , Adulto Joven , Complicaciones Posoperatorias/diagnóstico por imagenRESUMEN
In total hip arthroplasty (THA), determining the center of rotation (COR) and diameter of the hip joint (acetabulum and femoral head) is essential to restore patient biomechanics. This study investigates on-the-fly determination of hip COR and size, using off-the-shelf augmented reality (AR) hardware. An AR head-mounted device (HMD) was configured with inside-out infrared tracking enabling the determination of surface coordinates using a handheld stylus. Two investigators examined 10 prosthetic femoral heads and cups, and 10 human femurs. The HMD calculated the diameter and COR through sphere fitting. Results were compared to data obtained from either verified prosthetic geometry or post-hoc CT analysis. Repeated single-observer measurements showed a mean diameter error of 0.63 mm ± 0.48 mm for the prosthetic heads and 0.54 mm ± 0.39 mm for the cups. Inter-observer comparison yielded mean diameter errors of 0.28 mm ± 0.71 mm and 1.82 mm ± 1.42 mm for the heads and cups, respectively. Cadaver testing found a mean COR error of 3.09 mm ± 1.18 mm and a diameter error of 1.10 mm ± 0.90 mm. Intra- and inter-observer reliability averaged below 2 mm. AR-based surface mapping using HMD proved accurate and reliable in determining the diameter of THA components with promise in identifying COR and diameter of osteoarthritic femoral heads.
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Artroplastia de Reemplazo de Cadera , Realidad Aumentada , Cabeza Femoral , Prótesis de Cadera , Humanos , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/métodos , Tomografía Computarizada por Rayos X , Rotación , Masculino , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , FemeninoRESUMEN
BACKGROUND: Osteonecrosis of the femoral head (ONFH) often leads to the collapse of the femoral head, ultimately resulting in patients undergoing premature total hip arthroplasty (THA). The surgical hip dislocation (SHD) technique is a type of hip-preserving surgery aimed at delaying or avoiding THA. This study aims to evaluate the clinical efficacy of SHD techniques through femoral head fovea fenestration and impaction bone grafting for the treatment of non-traumatic ONFH. METHODS: A retrospective analysis was conducted on the clinical data of 39 patients (39 hips) with non-traumatic ONFH who underwent SHD for treatment from 2016 to 2017. The Harris hip score (HHS) and the minimum clinically important difference (MCID) are used to evaluate clinical outcomes, while radiographic evaluations are conducted using X-rays. Kaplan-Meier survival analysis defined clinical failure as further THA, and conducted univariate survival analysis and Cox regression analysis. Any complications were recorded. RESULTS: All patients were followed up for 24-72 months, with an average of (60 ± 13.0) months. At the last follow-up, based on the HHS, 25 patients (64.1%) reported excellent and good clinical outcomes. 29 patients (74.3%) achieved MCID. Imaging evaluation of the postoperative femoral head status showed that 6 cases improved, 20 cases remained stable, and 13 cases showed progressed. Out of 39 hips, 12 hips had postoperative clinical failure, resulting in a clinical success rate of 69.2%. Association Research Circulation Osseous (ARCO) stage, China-Japan Friendship Hospital (CJFH) classification, and postoperative crutch-bearing time are risk factors for clinical failure. Postoperative crutch-bearing time of less than 3 months is an independent risk factor for clinical failure. After surgery, there was one case of sciatic nerve injury and one case of heterotopic ossification. There were no infections or non-union of the greater trochanter osteotomy. CONCLUSION: The SHD technique through the femoral head fovea fenestration and impaction bone grafting provides a safe and effective method for treating non-traumatic ONFH, with good mid-term clinical outcomes. ARCO staging, CJFH classification, and postoperative crutch-bearing time are risk factors that affect clinical outcomes after surgery and lead to further THA. Insufficient postoperative crutch-bearing time is an independent risk factor for clinical failure.
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Trasplante Óseo , Necrosis de la Cabeza Femoral , Humanos , Estudios Retrospectivos , Masculino , Femenino , Trasplante Óseo/métodos , Adulto , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/etiología , Persona de Mediana Edad , Resultado del Tratamiento , Luxación de la Cadera/cirugía , Luxación de la Cadera/diagnóstico por imagen , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Estudios de Seguimiento , Adulto JovenRESUMEN
BACKGROUND: The surgical management of large osteochondral lesions of the femoral head in young, active patients remains controversial. Fresh osteochondral allograft (OCA) transplantation can be a highly effective treatment for these lesions in some patients. This study investigated survivorship as well as clinical and radiographic outcomes after fresh OCA transplantation at a minimum 2-year follow-up (mean, 6.6 years; range, 0.6 to 13.7 years). METHODS: A retrospective review of 29 patients who underwent plug OCA transplantation for focal femoral head osteochondral lesions between 2008 and 2021 was performed. Patients were assessed clinically using the modified Harris Hip score (mHHS) preoperatively and at each follow-up visit. Postoperative radiographs were evaluated for graft integrity and osteoarthritis severity. Kaplan-Meier survivorship analyses with 95% confidence intervals (CIs) were performed for the endpoint of conversion to total hip arthroplasty (THA). RESULTS: Overall graft survivorship for included patients was 78.4% (95% CI: 62.9 to 93.9) and 62.7% (95% CI: 39.6 to 85.8) at 5 and 10 years, respectively. There were ten patients (34.5%) who underwent conversion to THA. There was a significant difference using the log-rank test between survival for patients who had a preoperative diagnosis of osteonecrosis (ON) versus those who had other diagnoses (P = .002). The ten-year survival for those who had ON was 41.8% (95% CI: 4.8 to 78.8), and the ten-year survival for diagnoses other than ON was 85.7% (95% CI: 59.8 to 100). The mean mHHS score improved significantly (P < .001) from 48.9 (19 to 84) preoperatively to 77.4 (35 to 100) at the final follow-up. There were twenty patients (69.0%) who had mHHS ≥ 70 at the latest follow-up. Arthritic progression, indicated by an increase in the Kellgren and Lawrence grade, occurred in 7 hips (26.9%). CONCLUSIONS: An OCA transplantation is a viable treatment option for osteochondral defects of the femoral head in young, active patients who have minimal preexisting joint deformity. It may delay the progression of arthritis and the need for THA. Patients who had a preoperative diagnosis of ON had worse clinical outcomes than those who had other diagnoses.
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Aloinjertos , Trasplante Óseo , Cabeza Femoral , Humanos , Masculino , Femenino , Adulto , Estudios Retrospectivos , Estudios de Seguimiento , Cabeza Femoral/trasplante , Cabeza Femoral/cirugía , Resultado del Tratamiento , Persona de Mediana Edad , Trasplante Óseo/métodos , Adulto Joven , Adolescente , Cartílago Articular/cirugía , Trasplante Homólogo , Artroplastia de Reemplazo de Cadera/métodos , Supervivencia de InjertoRESUMEN
PURPOSE: The acetabular coverage in osteonecrosis of the femoral head (ONFH) affects the need for surgical intervention, and the collapse of the femoral head remains unclear. This study aimed to evaluate the relation between the acetabular coverage and the need for surgical treatment and femoral head collapse. METHODS: The study included 158 patients with 252 hips with glucocorticoid administration and idiopathic ONHF without osteoarthritis changes. The mean age at the first visit was 45.2 years, and the mean follow-up period was 92.2 months. All ONFH hips were subsequently divided into two groups: those needing surgical intervention and those without surgery. Additionally, it divided 167 initially non-collapsed hips into those that either later collapsed or not. Radiographic parameters with the centre-edge angle, acetabular roof obliquity, sharp angle, and necrotic location, following the guidelines of the Japanese Investigation Committee, were evaluated. RESULTS: There were no significant differences in radiographic parameters between the 106 hips that underwent surgery and the 146 hips without surgery. Among the 167 hips without initial collapse, 91 eventually collapsed while 76 did not; their radiographic findings have no significant differences. The necrotic locations were significantly larger in hips requiring surgical intervention or femoral head collapse. Furthermore, 21.8% (55 out of 252 hips) had acetabular dysplasia, which did not significantly correlate with the necessity for surgical treatment or the incidence of femoral head collapse. CONCLUSIONS: Acetabular coverage has little effect on the necessity for surgical treatment and femoral head collapse in ONFH patients over a long-term follow-up.
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Acetábulo , Necrosis de la Cabeza Femoral , Humanos , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/etiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Acetábulo/cirugía , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Radiografía/métodos , Estudios Retrospectivos , Anciano , Adulto Joven , Glucocorticoides/uso terapéutico , Glucocorticoides/administración & dosificaciónRESUMEN
Background: The purpose of this study was to evaluate functional outcomes, radiologic results, and complications after hybrid total hip arthroplasty (THA) in patients with subchondral insufficiency fractures (SIFs) of the femoral head. Methods: From June 2009 to December 2020, among 985 patients who underwent hybrid THA at our hospital, 19 patients diagnosed with SIF through a retrospective chart review were included. Those under 50 years of age, with radiographic findings of osteonecrosis on the contralateral side of surgery, a history of organ transplantation, and alcohol abuse, were excluded. Functional evaluation was performed using a modified Harris Hip Score (HHS). After surgery, inclination and anteversion of the acetabular cup and version of the femoral system were measured using postoperative x-ray. The outpatient follow-up was performed at 6 weeks, 3 months, 9 months, and 12 months after surgery and every year thereafter. Complications including dislocation, implant loosening, stem subsidence, and periprosthetic infection were observed on follow-up radiographs. Results: The average follow-up time was 29.3 ± 9.1 months (range, 24-64 months) with no loss to follow-up. The mean modified HHS was 83.4 ± 9.6 (range, 65-100) at the last outpatient clinic follow-up. The average inclination of the acetabular cup was 41.9° ± 3.4° (range, 37°-48°), and the anteversion was 27.5° ± 6.7° (range, 18°-39°). The version of the femoral stem was 19° ± 5.7° (range, 12°-29°). There was no case of intraoperative fracture. There were no cases of dislocation, loosening of the cup, subsidence of the femoral stem, intraoperative or periprosthetic fracture, or periprosthetic infection on the follow-up radiographs. Conclusions: In our study, hybrid THA showed favorable outcomes in patients diagnosed with SIF, and there were no further special considerations as for THA performed due to other diseases or fractures.
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Artroplastia de Reemplazo de Cadera , Fracturas por Estrés , Humanos , Artroplastia de Reemplazo de Cadera/efectos adversos , Persona de Mediana Edad , Masculino , Femenino , Estudios Retrospectivos , Fracturas por Estrés/cirugía , Fracturas por Estrés/diagnóstico por imagen , Fracturas por Estrés/etiología , Adulto , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/lesiones , Anciano , Fracturas de Cadera/cirugía , Fracturas de Cadera/diagnóstico por imagen , Complicaciones PosoperatoriasRESUMEN
BACKGROUND: To analyze the risk factors for the development of avascular necrosis (AVN) of the femoral head after reduction surgery in children with developmental hip dysplasia (DDH), and to establish a prediction nomogram. METHODS: The clinical data of 134 children with DDH (169 hips) treated with closure reduction or open reduction from December 2016 to December 2019 were retrospectively analyzed. Independent risk factors for AVN after DDH reduction being combined with cast external immobilization were determined by univariate analysis and multivariate logistic regression and used to generate nomograms predicting the occurrence of AVN. RESULTS: A total of 169 hip joints in 134 children met the inclusion criteria, with a mean age at surgery of 10.7 ± 4.56 months (range: 4-22 months) and a mean follow-up duration of 38.32 ± 27.00 months (range: 12-94 months). AVN developed in 42 hip joints (24.9%); univariate analysis showed that the International Hip Dysplasia Institute (IHDI) grade, preoperative development of the femoral head ossification nucleus, cartilage acetabular index, femoral head to acetabular Y-shaped cartilage distance, residual acetabular dysplasia, acetabular abduction angle exceeding 60°, and the final follow-up acetabular index (AI) were associated with the development of AVN (P < 0.05). Multivariate logistic regression analysis showed that the preoperative IHDI grade, development of the femoral head ossification nucleus, acetabular abduction angle exceeding 60°, and the final follow-up AI were independent risk factors for AVN development (P < 0.05). Internal validation of the Nomogram prediction model showed a consistency index of 0.833. CONCLUSION: Preoperative IHDI grade, preoperative development of the femoral head ossification nucleus, final AI, and acetabular abduction angle exceeding 60° are risk factors for AVN development. This study successfully constructed a Nomogram prediction model for AVN after casting surgery for DDH that can predict the occurrence of AVN after casting surgery for DDH.
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Displasia del Desarrollo de la Cadera , Necrosis de la Cabeza Femoral , Nomogramas , Humanos , Masculino , Femenino , Necrosis de la Cabeza Femoral/etiología , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Factores de Riesgo , Estudios Retrospectivos , Displasia del Desarrollo de la Cadera/cirugía , Displasia del Desarrollo de la Cadera/diagnóstico por imagen , Lactante , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Luxación Congénita de la Cadera/cirugía , Luxación Congénita de la Cadera/diagnóstico por imagen , Estudios de SeguimientoRESUMEN
BACKGROUND: Femoral head varus triggers poor clinical prognosis in intertrochanteric fracture patients with proximal femoral nail antirotation (PFNA) fixation. Studies present that changes in nail position and screw insertion angles will affect fixation stability, but the biomechanical significance of these factors on the risk of femoral head varus has yet to be identified in PFNA fixed patients. METHODS: Clinical data in PFNA fixed intertrochanteric fracture patients have been reviewed, the relative position of intermedullary nail has been judged in the instant postoperative lateral radiography. Regression analyses have been performed to identify the effect of this factor on femoral head varus. Corresponding biomechanical mechanism has been identified by numerical mechanical simulations. RESULTS: A clinical review revealed that ventral side nail insertion can trigger higher risk of femoral head varus, corresponding numerical mechanical simulations also recorded poor fixation stability in models with ventral side nail insertion, and changes in the trajectory of anti-rotation blade will not obviously affect this tendency. CONCLUSIONS: Ventral side insertion of intramedullary nail can trigger higher risk of femoral head varus in PFNA fixed patients by deteriorating the instant postoperative biomechanical environment, and changes in blade trajectory cannot change this tendency biomechanically. Therefore, this nail position should be adjusted to optimize patients' prognosis.
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Clavos Ortopédicos , Cabeza Femoral , Fijación Intramedular de Fracturas , Fracturas de Cadera , Humanos , Fenómenos Biomecánicos , Cabeza Femoral/cirugía , Cabeza Femoral/fisiopatología , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/instrumentación , Fracturas de Cadera/cirugíaRESUMEN
Currently, there is a lack of relevant research on the efficacy difference between SHD combined with IBG and PVIBGT in the treatment of osteonecrosis of the femoral head(ONFH). Firstly, this study intends to compare the effectiveness of surgical hip dislocation combined with impacting bone grafts (SHD-IBG) and pedicled vascularised iliac bone graft transfer (PVIBGT) in treating ONFH. And the study investigates patients who suffered from hip preservation failures from both groups to better comprehend failure reasons. 30 patients (34 hips) with ARCO stage IIIA femoral head necrosis were selected between January 2012 and July 2022. They were divided into group A(SHD-IBG) and group B (PVIBGT) according to different surgical methods. Firstly, compared the 1-year effect between SHD-IBG and PVIBGT at 1 year postoperatively; Secondly, assessed the medium and long-term efficacy of SHD-IBG hip preservation treatment; Lastly, based on study of the femoral head removed from patients with hip preservation failure in the two groups, the reasons for the failure of hip preservation were comprehensively analyzed in the two groups. Group A: 11 males (13 hips), 4 females (4 hips);Group B: 9 males (11 hips), 6 females (6 hips).Firstly, the average Harris scores of the two groups at 1 year after surgery: preoperative: 70.7, 1 year after surgery: 78.9 in group A; preoperative: 69.5, 1 year after surgery: 81.5 in group B. The differences were statistically significant (P < 0.05).Compared to the preoperative period, quantitative analysis by DCE-MRI showed an increase in perfusion in the necroticarea and an improvement in hyperperfusion in the repair-responsive area one year after the surgery. Secondly, in group A, the hip preservation rate was 88.2% at 2.5-11 (average of 77 months) years of follow-up, and the mean Harris score at the last follow-up was 73.2.Semi-quantitative analysis of postoperative DCE-MRI showed that the perfusion curves of necrotic and repaired areas were similar to those of the normal area. This suggests the instability within the femoral head had been effectively improved, and the perfusion had partially recovered. Thirdly, according to Micro-CT and pathologica studies of patients with hip preservation failure in these two groups, all these patients' femoral head was significantly collapsed and deformed. Their trabeculae was thin and partially disorganized, with fractures in the subchondral bone and separation of the cartilage from the subchondral bone. The necrotic areas had sparse trabeculae, disorganized arrangement, loss of continuity, and disappearance of cells in the trabecular traps. The necrotic area was covered with fibrous tissue, and partial restoration was observed in the repair area. Mechanical finite element analysis showed that the maximum equivalent force was observed in the weight- bearing area and the cortical bone surrounding the shaft of femurand. The result of DCE-MRI showed that the repair reaction area exhibited abnormal hyperperfusion. In this study, the efficacy of SHD-IBG and PVIBGT was compared at 1 year after operation, and the long-term follow-up of SHD-IBG was 2.5-11 (mean 77 months) years, combined with DCE-MRI results, we found that the short-term effect of PVIBGT was more significant than that of SHD-IBG. SHD-IBG can achieve satisfactory hip preservation in the medium and long term follow-up.
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Trasplante Óseo , Necrosis de la Cabeza Femoral , Humanos , Femenino , Masculino , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/patología , Adulto , Persona de Mediana Edad , Trasplante Óseo/métodos , Resultado del Tratamiento , Ilion/diagnóstico por imagen , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/patología , Cabeza Femoral/cirugía , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/cirugíaRESUMEN
CASE: This is a first report describing preservation of the femoral head by transcervical resection of proximal femoral Ewing sarcoma in 2 pediatric patients. A unique Capanna reconstruction supported joint salvage. At 1 year, Pediatric Outcomes Data Collection Instrument and Pediatric Toronto Extremity Salvage Score outcomes were excellent. Surveillance magnetic resonance imaging was without evidence of recurrence or impaired perfusion to the femoral head. CONCLUSION: We demonstrate the feasibility of hip joint preservation and maintenance of femoral head viability after transcervical resection of pediatric proximal femur bone sarcomas while preserving the medial circumflex femoral artery. This technique may be a preferred option over joint sacrifice and endoprosthetic replacement in young patients when tumor margins permit.
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Neoplasias Femorales , Sarcoma de Ewing , Humanos , Neoplasias Óseas/cirugía , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Femorales/cirugía , Neoplasias Femorales/diagnóstico por imagen , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Procedimientos de Cirugía Plástica/métodos , Sarcoma de Ewing/cirugía , Sarcoma de Ewing/diagnóstico por imagenRESUMEN
Femoral head varus is an important complication in intertrochanteric fracture patients treated with proximal femoral nail anti-rotation (PFNA) fixation. Theoretically, extending the length of the intramedullary nail could optimize fixation stability by lengthening the force arm. However, whether extending the nail length can optimize patient prognosis is unclear. In this study, a review of imaging data from intertrochanteric fracture patients with PFNA fixation was performed, and the length of the intramedullary nail in the femoral trunk and the distance between the lesser trochanter and the distal locking screw were measured. The femoral neck varus status was judged at the 6-month follow-up. The correlation coefficients between nail length and femoral neck varus angle were computed, and linear regression analysis was used to determine whether a change in nail length was an independent risk factor for femoral neck varus. Moreover, the biomechanical effects of different nail lengths on PFNA fixation stability and local stress distribution have also been verified by numerical mechanical simulations. Clinical review revealed that changes in nail length were not significantly correlated with femoral head varus and were also not an independent risk factor for this complication. In addition, only slight biomechanical changes can be observed in the numerical simulation results. Therefore, commonly used intramedullary nails should be able to meet the needs of PFNA-fixed patients, and additional procedures for longer nail insertion may be unnecessary.
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Clavos Ortopédicos , Fijación Intramedular de Fracturas , Fracturas de Cadera , Humanos , Fenómenos Biomecánicos/fisiología , Fijación Intramedular de Fracturas/instrumentación , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/efectos adversos , Femenino , Masculino , Anciano , Fracturas de Cadera/cirugía , Fracturas de Cadera/diagnóstico por imagen , Cabeza Femoral/cirugía , Cabeza Femoral/diagnóstico por imagen , Anciano de 80 o más Años , Factores de Riesgo , Persona de Mediana Edad , Simulación por ComputadorRESUMEN
PURPOSE: Templating is the first step in achieving a successful total hip arthroplasty. We hypothesize that native head size is highly correlated with implanted cup size. Therefore, the purpose of this study is to look for a correlation between sizes of the intra-operative measurement of the femoral head and the implanted cup. METHODS: This is a monocentric observational study conducted from December 2018 till January 2023. All patients admitted for a primary total hip arthroplasty were included and retrospectively reviewed. Intra-operative femoral head measurement, radiographic femoral head diameter, templated (planned) cup size, and definitive implanted cup size were recorded. RESULTS: The sample included 154 patients (85 female and 69 males) with a mean age of 66.2 ± 10.4 years. There were 157 THA cases; 82 on the right side and 75 on the left side. The native head size and acetate template on digital radiographs were the most significantly positively correlated with cup size (P < 0.0001) while the radiological head size was significantly negatively correlated with cup size (P = 0.009). The implanted cup was on average 2 ± 2 mm bigger than the native head size measured intra-operatively. CONCLUSION: The native femoral head diameter measured intra-operatively is a simple and reliable tool to help the surgeons choose the proper size of the acetabular cup, preventing complications during surgery hence optimizing results post operatively. This technique would contribute to a more ecofriendly orthopaedic reconstructive surgery.
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Acetábulo , Artroplastia de Reemplazo de Cadera , Cabeza Femoral , Prótesis de Cadera , Humanos , Femenino , Masculino , Anciano , Artroplastia de Reemplazo de Cadera/métodos , Artroplastia de Reemplazo de Cadera/instrumentación , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Cabeza Femoral/anatomía & histología , Estudios Retrospectivos , Persona de Mediana Edad , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Acetábulo/anatomía & histología , Diseño de Prótesis , Anciano de 80 o más Años , Ajuste de Prótesis/métodosRESUMEN
The implantation of uncemented prostheses requires the application of sufficient forces to achieve a press-fit of the implant in the bone. Excessive forces have to be omitted to limit bone damage. Force measurements along the force transmission path between mallet and implant are frequently used to investigate this trade-off. Placing a load cell at a position of interest (PoI), which might be the implant bone interface or the head taper junction, is technically challenging or even impossible so that nearby positions are chosen. Thus, a certain inertia and stiffness remain between the PoI and the sensor, and consequently the measured dynamic forces differ from those at the PoI. This experimental and numerical study aimed to investigate the amount of force reduction along the transmission path while joining femoral heads to stem tapers. Forces were measured in vitro at the tip of the mallet, directly above the polymer tip of the impactor and below the stem taper. Springs and masses were used to represent the responding tissue of a patient. A semi-empirical numerical model of the force transmission path was developed and validated in order to simulate a larger range of responding tissue properties than experimentally possible and to investigate the influence of different surgical instruments. A distinct attenuation was observed since the peak forces at the impactor reached 35% of the applied peak forces and 21% at the stem taper, respectively. The force curves were replicated with a median root mean square error of 3.8% of the corresponding mallet blow for the impactor and 3.6% for the stem. The force measurement position and the used surgical instruments have a strong influence on the measured forces. Consequently, the exact measurement conditions with regard to sensor positioning and used surgical instruments have to be specified and hence only studies with similar setups should be compared to avoid misestimation of the forces at the PoI. The proposed dynamic numerical model is a useful tool to calculate the impact of the chosen or changed mechanical parameters prior to executing experiments and also to extrapolate the effect of changing the applied forces to the resulting forces at the PoI.
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Prótesis de Cadera , Humanos , Estrés Mecánico , Fenómenos Biomecánicos , Cabeza Femoral/fisiología , Cabeza Femoral/cirugía , Modelos TeóricosRESUMEN
BACKGROUND: Patients undergoing primary total hip arthroplasty (THA) who have spinal deformity and a stiff spine are the highest-risk group for instability. Despite the increasing use of dual-mobility cups and large femoral heads, dislocation remains a major complication after THA. Preoperative planning becomes a critical aspect of ensuring precise component positioning within a safe zone. The purpose of this study was to investigate dislocation rates over a 9-year period. METHODS: A retrospective review of 4,731 THAs performed by 3 orthopaedic surgeons between January 2014 and March 2023 was performed. Spinopelvic measurements were conducted to determine the hip-spine classification group for each patient. Only patients classified as 2B (pelvic incidence-lumbar lordosis > 10° and Δsacral slope < 10°) were eligible. Both absolute and relative dislocation frequencies were then analyzed using time-series analysis techniques and Fisher's exact tests. RESULTS: A total of 281 hip-spine 2B patients undergoing primary THA were eligible for analysis (57% women; mean age, range: 66 years, 23 to 87; mean body mass index, range: 28, 16 to 45). The overall dislocation rate was 4.3%. Use of femoral head sizes ≥ 40 mm increased from 4% in 2014 to 2019 to 37% in 2020 to 2023 (P < .001), while the use of dual-mobility cups decreased from 100% in 2014 to 2019 to 37% in 2020 to 2023 (P < .001). Acetabular component planning was changed from the supine plane to the standing plane in February 2020. Those changes in surgical practice were notably correlated with a significant decrease in dislocation rates from 6.8% in 2014 to 2019 to 1.5% in 2020 to 2023 (P = .03). CONCLUSIONS: Our study demonstrates that the introduction of advanced preoperative THA planning to the standing plane, coupled with precise intraoperative technology for implant placement, can significantly reduce the risk of instability in high-risk THA patients. Notably, we observed a significant decrease in dislocation rates, which aligned with the shift in surgical practice. LEVEL OF EVIDENCE: IV.
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Artroplastia de Reemplazo de Cadera , Humanos , Artroplastia de Reemplazo de Cadera/instrumentación , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Femenino , Masculino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Adulto , Anciano de 80 o más Años , Prótesis de Cadera/efectos adversos , Inestabilidad de la Articulación/etiología , Luxación de la Cadera/etiología , Luxación de la Cadera/cirugía , Adulto Joven , Articulación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Cabeza Femoral/cirugíaRESUMEN
Aims: Ganz's studies made it possible to address joint deformities on both the femoral and acetabular side brought about by Perthes' disease. Femoral head reduction osteotomy (FHRO) was developed to improve joint congruency, along with periacetabular osteotomy (PAO), which may enhance coverage and containment. The purpose of this study is to show the clinical and morphological outcomes of the technique and the use of an implemented planning approach. Methods: From September 2015 to December 2021, 13 FHROs were performed on 11 patients for Perthes' disease in two centres. Of these, 11 hips had an associated PAO. A specific CT- and MRI-based protocol for virtual simulation of the corrections was developed. Outcomes were assessed with radiological parameters (sphericity index, extrusion index, integrity of the Shenton's line, lateral centre-edge angle (LCEA), Tönnis angle), and clinical parameters (range of motion, visual analogue scale (VAS) for pain, Merle d'Aubigné-Postel score, modified Harris Hip Score (mHHS), and EuroQol five-dimension five-level health questionnaire (EQ-5D-5L)). Early and late complications were reported. Results: The mean follow-up was 39.7 months (standard deviation (SD) 26.4). The mean age at surgery was 11.4 years (SD 1.6). No major complications were recorded. One patient required a total hip arthroplasty. Mean femoral head sphericity increased from 46.8% (SD 9.34%) to 70.2% (SD 15.44; p < 0.001); mean LCEA from 19.2° (SD 9.03°) to 44° (SD 10.27°; p < 0.001); mean extrusion index from 37.8 (SD 8.70) to 7.5 (SD 9.28; p < 0.001); and mean Tönnis angle from 16.5° (SD 12.35°) to 4.8° (SD 4.05°; p = 0.100). The mean VAS improved from 3.55 (SD 3.05) to 1.22 (1.72; p = 0.06); mean Merle d'Aubigné-Postel score from 14.55 (SD 1.74) to 16 (SD 1.6; p = 0.01); and mean mHHS from 60.6 (SD 18.06) to 81 (SD 6.63; p = 0.021). The EQ-5D-5L also showed significant improvements. Conclusion: FHRO associated with periacetabular procedures is a safe technique that showed improved functional, clinical, and morphological outcomes in Perthes' disease. The newly introduced simulation and planning algorithm may help to further refine the technique.
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Cabeza Femoral , Enfermedad de Legg-Calve-Perthes , Osteotomía , Adolescente , Niño , Femenino , Humanos , Masculino , Acetábulo/cirugía , Acetábulo/diagnóstico por imagen , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Enfermedad de Legg-Calve-Perthes/cirugía , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Imagen por Resonancia Magnética , Osteotomía/métodos , Rango del Movimiento Articular , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
INTRODUCTION: The importance of the assembly procedure on the taper connection strength is evident. However, existent surgical technique guides frequently lack comprehensive and precise instructions in this regard. The aim of our experimental study was to evaluate the influence of the surgical technique guide on the femoral head assembly procedure in surgeons with differing levels of experience in total hip arthroplasty. MATERIALS AND METHODS: Twenty-eight participants, divided into four groups based on their lifetime experience in total hip arthroplasty, conducted a femoral head assembly procedure in a simulated intraoperative environment before and after reviewing the surgical technique guide. Demographic information and the number of hammer blows were documented. Hammer velocity and impaction angle were recorded using an optical motion capturing system, while the impaction force was measured using a dynamic force sensor within the impactor. RESULTS: We observed a high variation in the number of hammer blows, maximum force, and impaction angle. Overall, the number of hammer blows decreased significantly from 3 to 2.2 after reviewing the surgical technique guide. The only significant intragroup difference in the number of hammer blows was observed in the group with no prior experience in total hip arthroplasty. No correlation was found between individual factors (age, weight, height) or experience and the measured parameters (velocity, maximum force and angle). CONCLUSIONS: The present study demonstrated a high variation in the parameters of the femoral head assembly procedure. Consideration of the surgical technique guide was found to be a limited factor among participants with varying levels of experience in total hip arthroplasty. These findings underline the importance of sufficient preoperative training, to standardize the assembly procedure, including impaction force, angle, and use of instruments.
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Artroplastia de Reemplazo de Cadera , Competencia Clínica , Cabeza Femoral , Humanos , Artroplastia de Reemplazo de Cadera/métodos , Cabeza Femoral/cirugía , Masculino , Femenino , Prótesis de Cadera , Adulto , Persona de Mediana EdadRESUMEN
CASE: We describe the unique case of a 20-year-old man with a history of Legg-Calve-Perthes disease, hip dysplasia, and osteochondral fragmentation of the medial femoral head. We performed arthroscopic femoroplasty and femoral head allografting, followed by a valgus-producing derotational femoral osteotomy (DFO) and periacetabular osteotomy (PAO). At 1-year follow-up, the patient achieved osseous union and complete femoral head healing with return to his active hobbies. CONCLUSION: We describe the successful utilization of arthroscopic allografting for medial femoral head osteochondral fragmentation. To our knowledge, this is the first report on femoral head arthroscopic allografting before DFO and PAO.