Total Hip Arthroplasty After Proximal Femoral Nailing: Preoperative Preparation and Intraoperative Surgical Techniques
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ABSTRACT:
SUBMITTER: Puri S
PROVIDER: S-EPMC10641077 | biostudies-literature | 2023 Oct
REPOSITORIES: biostudies-literature
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Project description:Dislodgment of trial femoral heads and migration into the pelvis during total hip arthroplasty is a rarely reported complication with limited published cases. There are three primary mechanisms of femoral head separation: dislodgement during reduction attempt, disassociation from anterior dislocation while assessing anterior stability, and during dislocation after implant trialing. If the trial femoral migrates beyond the pelvic brim, it is safer to finish the total hip arthroplasty and address the retained object after repositioning or in a planned second procedure with a general surgeon. We recommend operative retrieval since long-term complications from retention or clinical results are lacking.
| S-EPMC5859736 | biostudies-literature
Project description:ObjectiveTotal hip arthroplasty (THA) combined with proximal femoral reconstruction is a novel osteotomy technique developed to address severe hip deformities. There is a paucity of robust clinical and radiological evidence regarding the outcomes of this novel osteotomy technique. This study aimed to evaluate the clinical and radiological outcomes of THA combined with proximal femoral reconstruction during the early follow-up.MethodsThis is a retrospective case series of 63 hips who underwent THA combined with proximal femoral reconstruction at a single institution between January 2020 and July 2023. The mean age of patients was 39.6 ± 12.6 years. The mean follow-up was 25.6 ± 3.8 months. Surgical characteristics and perioperative variables were evaluated to assess the efficacy of this technique. Harris hip score (HHS) was utilized to evaluate hip function. Leg length discrepancy (LLD) was evaluated in X-ray. The incidence of major adverse events including deep vein thrombosis (DVT), osteolysis, nonunion of the osteotomy, intraoperative femoral fracture, and infection was also evaluated. Paired-samples t-test was used to compare preoperative and postoperative HHS and LLD.ResultsThe mean operative time was 125.1 min. The mean size of the acetabular components used was 45.2 mm, and the stem size was 7.5. The primary friction interface was ceramic-on-ceramic, accounting for 92.1% of cases. The average length of hospital stay was 8.5 days. The mean cost of treatment was 46,296.0 Yuan. There was a significant improvement in postoperative HHS (p < 0.001) and LLD (p < 0.001) compared to preoperative values. The incidence of deep venous thrombosis was 4.8%; osteolysis rates for the cup and stem were 4.8% and 6.4%, respectively. The non-union and dislocation rates were 1.6% and 3.2%, respectively. There was no incidence of postoperative infection.ConclusionThe novel osteotomy surgical procedure yields reliable and impressive clinical and radiological outcomes, with minimal complications. We advocate for its use in complex primary THA cases involving severe proximal femoral deformities.
| S-EPMC11293906 | biostudies-literature
Project description:Porous tantalum augments are widely used in revision total hip arthroplasty for the reconstruction of severe bone defects. Here, we present the first 3 cases who underwent femoral revision arthroplasty using standard distal femoral and proximal tibial porous tantalum cones to reconstruct severe bone loss in the proximal femur. Cones were inserted press fit, followed by implantation of a cemented revision stem in all cases. After a mean follow-up period of 15.8 months, all patients showed an improved Harris-Hip-Score and no radiological signs of subsidence or loosening. Porous tantalum cones may be an option in the reconstruction of severe femoral defects in revision total hip arthroplasty. The shape of the tantalum cones should be optimized for the use in the proximal femur.
| S-EPMC8079334 | biostudies-literature
Project description:There are an increasing number of vascular complications after hip replacement, some of which can be life-threatening. However, there are few reports of lower limb ischemic symptoms after undergoing an otherwise uncomplicated classic total hip replacement. We report a patient with low weight who developed postoperative limb ischemia resulting from blood clots caused by insertion of a Hohmann retractor close to small anterior acetabular osteophytes. Ultrasonography and angiography revealed her symptoms to be the result of femoral artery intimal injury with lower extremity arterial thrombosis, which led to pain, numbness, and decreased skin temperature. The patient underwent timely percutaneous intervention with a femoral artery stent, which relieved her symptoms. The discussion reviews femoral artery injury during total hip arthroplasty.
| S-EPMC6287226 | biostudies-literature
Project description:Proximal femoral fracture in an ankylosed hip is a challenging condition. There is no consensus on fixation method for these fractures. In addition, despite union the best outcome possible is the restoration of the pre morbid status. We report two different presentations of proximal femoral fracture in ankylosed hip that were successfully treated with primary total hip arthroplasty. We also discuss the surgical principles, technique and advantages of doing primary total hip arthroplasty in such cases.
| S-EPMC6985166 | biostudies-literature
Project description:OBJECTIVE:To introduce a modified osteotomy method for proximal femur reconstruction (PFR) in total hip arthroplasty (THA) for high developmental dysplasia of the hip (DDH). METHOD:A retrospective study was performed in a series of 24 patients (26 hips) with Crowe III/IV DDH who underwent THA and simultaneous PFR. We used an animated video to illustrate and help understand the procedure for this technique. Patients were reviewed clinically and radiographically with an average follow-up of 31 months. The Harris hip score (HHS) was recorded preoperatively and at 3 and 12 months postoperatively. RESULTS:All patients achieved primary bone union. No revision was needed up to the latest follow-up. One patient had a dislocation due to self-fall and received manual reduction under general anesthesia. No patient had intraoperative femoral fractures, sciatic nerve injury, or infection. The mean HHS improved from 33.48 ± 9.06 preoperatively to 84.61 ± 4.78 immediately after surgery and 90.84 ± 4.96 at 12 months. CONCLUSION:Proximal femur reconstruction is a simple and practical technique for femoral remolding during THA in patients with high DDH.
| S-EPMC7031569 | biostudies-literature
Project description:We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabular components, previous history of hip arthroplasty, history of pelvic trauma or intrapelvic surgery, and poor bone quality. Management of bladder injury, should it occur, includes bladder decompression with a Foley catheter, antibiotic administration, hemodynamic monitoring, and urology consult with close follow-up. This case reinforces the importance of urologic preoperative evaluation for anatomic variations of the bladder. In such cases, intraoperative Foley catheters to prevent distension may reduce the risk of perforation.
| S-EPMC5859462 | biostudies-literature
Project description:BackgroundThe influence of the surgical process on implant loosening and periprosthetic fractures (PPF) as major complications in uncemented total hip arthroplasty (THA) has rarely been studied because of the difficulty in quantification. Meanwhile, registry analyses have clearly shown a decrease in complications with increasing experience. The goal of this study was to determine the extent of variability in THA stem implantation between highly experienced surgeons with respect to implant size, position, press-fit, contact area, primary stability, and the effect of using a powered impaction tool.MethodsPrimary hip stems were implanted in 16 cadaveric femur pairs by three experienced surgeons using manual and powered impaction. Quantitative CTs were taken before and after each process step, and stem tilt, canal-fill-ratio, press-fit, and contact determined. Eleven femur pairs were additionally tested for primary stability under cyclic loading conditions.ResultsManual impactions led to higher variations in press-fit and contact area between the surgeons than powered impactions. Stem tilt and implant sizing varied between surgeons but not between impaction methods. Larger stems exhibited less micromotion than smaller stems.ConclusionsLarger implants may increase PPF risk, while smaller implants reduce primary stability. The reduced variation for powered impactions indicates that appropriate measures may promote a more standardized process. The variations between these experienced surgeons may represent an acceptable range for this specific stem design. Variability in the implantation process warrants further investigations since certain deviations, for example, a stem tilt toward varus, might increase bone stresses and PPF risk.
| S-EPMC8789517 | biostudies-literature
Project description:ObjectiveTo evaluate the outcomes of total hip arthroplasty (THA) with subtrochanteric femoral shortening osteotomy for high hip dislocation.MethodsIn this retrospective study, the results of 24 primary THAs with acetabular reconstruction and subtrochanteric femoral shortening osteotomy in 21 patients with high hip dislocation were evaluated. The acetabula were reconstructed with cemented or uncemented cups and bone grafting. Transverse subtrochanteric femoral shortening osteotomies were applied and the osteotomy sites treated by bone grafting and cable fixation. Assessment was by Hip Harris scores and radiographic evaluation.ResultsThe mean follow-up time was 42 months (18-108 months), three cases being lost to follow-up 18-27 months postoperatively. The HHS improved from 47.5 ± 8.7 to 88.5 ± 3.1. The mean length of femoral segments removed was 2.5 ± 0.8 cm (range, 1.0-4.5 cm) and mean acetabular inclination 43° ± 5° (range, 31°-54°). Caudalization of the femoral head center was 3.2 ± 3.0 mm (range, -3 to 12 mm) and lateralization 4.0 ± 4.0 mm (range, -9 to 11 mm). Mean greater trochanter height relative to theoretical hip center was 5.2 ± 1.0 cm (range, 3.5-7.1 cm) preoperatively and 0.2 ± 0.6 cm (range, -0.9 to 1.2 cm) postoperatively. Intraoperative trochanteric fractures occurred in three cases and sciatic nerve palsy in one.ConclusionTHA with subtrochanteric femoral shortening osteotomy is an effective technique for treating high hip dislocation. Its advantages include improvement in limb imbalance and decreased risk of sciatic nerve injury.
| S-EPMC6583667 | biostudies-literature
Project description:ObjectivePeriprosthetic fracture in total hip arthroplasty (THA) can be catastrophic, and early detection and appropriate management are vital to the overall prognosis. This study aimed to describe and summarize the features of undetected intraoperative periprosthetic femoral fractures (IPFFs) in primary THA patients and treatment measures and to review the relevant literature.MethodsWe reviewed a total of 6350 primary THAs performed at our institution between January 2013 and December 2020 and screened all IPFFs. Of 138 IPFFs, 24 were undetected and met the inclusion criteria. We recorded and compared basic patient and operative information and measured some parameters to evaluate canal morphologies based on preoperative radiographs. We also compared fracture line characteristics using postoperative radiographs to summarize the features of intraoperative fractures and propose treatment strategies. The Kolmogorov-Smirnov test was used to test the normality of the variable distributions. Measured parameters in all groups were analyzed using one-way analysis of variance and compared using Dunnett's test. The χ2 and Fisher exact tests were used to compare reoperation rates across the groups. Interrater and intrarater reliability were evaluated by intraclass correlation coefficients.ResultsAmong the 24 hips, there was no significant difference in patient demographics, basic operative information or morphology. The incidence of IPFFs in primary THA patients was 2.17%, and up to 17.4% of IPFFs were undetected until postoperative fluoroscopy. The incidence of undetected IPFFs among all primary THA patients was 0.38% and varied by stem type, with the highest incidence in femurs with either anatomical (1.04%, 4/385) or modular stems (0.90%, 9/1003). Femurs with anatomical stems had a higher reoperation rate. The distal periprosthetic (Gruen zone 4) fracture line of femurs with tapered stems was more prone to involve the medial or lateral bone cortex, which could cause instability.ConclusionAn undetected IPFF is most likely in femurs fitted with a prosthesis of an inappropriate size or type. Anatomical stems will most likely cause unstable fractures; thus, it is recommended to use them with caution and note the possibility of medial distal femoral fracture. Improper modular stem type or size selection results in longitudinal fractures of the distal femur, and prophylactic cerclage wire binding is recommended in dysplastic hips. Incorrect use of tapered stems in well-ossified femurs may cause distal femoral fractures involving the medial or lateral bone cortex. Intraoperative fluoroscopy after implantation may help detect hidden fractures.
| S-EPMC9977600 | biostudies-literature