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Management of Blood Loss in Hip Arthroplasty: Korean Hip Society Current Consensus.

Joo Hyoun SONG ; Jang Won PARK ; Young Kyun LEE ; In Sung KIM ; Jae Hwi NHO ; Kyung Jae LEE ; Kwan Kyu PARK ; Yeesuk KIM ; Jai Hyung PARK ; Seung Beom HAN

Hip & Pelvis.2017;29(2):81-90. doi:10.5371/hp.2017.29.2.81

The volume of hip arthroplasty is stiffly increasing because of excellent clinical outcomes, however it has not been shown to decrease the incidence of transfusions due to bleeding related to this surgery. This is an important consideration since there are concerns about the side effects and social costs of transfusions. First, anemia should be assessed at least 30 days before elective hip arthroplasty, and if the subject is diagnosed as having anemia, an additional examination of the cause of the anemia should be carried and steps taken to address the anemia. Available iron treatments for anemia take 7 to 10 days to facilitate erythropoiesis, and preoperative iron supplementation, either oral or intravenous, is recommended. When using oral supplements for iron storage, administer elemental iron 100 mg daily for 2 to 6 weeks before surgery, and calculate the dose using intravenous supplement. Tranexamic acid (TXA) is a synthetic derivative of the lysine component, which reduces blood loss by inhibiting fibrinolysis and clot degradation. TXA is known to be an effective agent for reducing postoperative bleeding and reducing the need for transfusions in primary and revision total hip arthroplasties. Patient blood management has improved the clinical outcome after hip arthroplasty through the introduction and research of various agents, thereby reducing the need for allogeneic blood transfusions and reducing the risk of transfusion-related infections and the duration of hospitalizations.
Anemia ; Arthroplasty* ; Blood Transfusion ; Consensus* ; Erythropoiesis ; Fibrinolysis ; Hemorrhage ; Hip* ; Hospitalization ; Humans ; Incidence ; Iron ; Lysine ; Tranexamic Acid

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Acute Isolated Tear of Gluteus Medius in Young Male.

Seung Rim YI ; Jieun KWON ; Joon Hee CHO

Hip & Pelvis.2017;29(4):291-293. doi:10.5371/hp.2017.29.4.291

The hip rotator cuff tear usually develops in the middle-aged through gradual degenerative changes, similar to rotator cuff tears in the shoulder. An acute tear in the hip abductor by a traumatic event in young ages is very uncommon. The authors experienced an unusual case of an acute traumatic tear isolated to the gluteus medius in a young male; thus, we report the treatment results in this rare case with a review of the literature.
Hip ; Hip Injuries ; Humans ; Male* ; Rotator Cuff ; Shoulder ; Tears* ; Young Adult

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Risk Factors for Neck Shortening in Patients with Valgus Impacted Femoral Neck Fractures Treated with Three Parallel Screws: Is Bone Density an Affecting Factor?.

Yerl Bo SUNG ; Eui Yub JUNG ; Kyung Il KIM ; Soo Yeon KIM

Hip & Pelvis.2017;29(4):277-285. doi:10.5371/hp.2017.29.4.277

PURPOSE: The purpose of this study is to analyze the relationship between significant femoral neck shortening (SFNS) and bone density after three parallel screw fixation in valgus impacted femoral neck fracture, and to analyze the risk factors for SFNS. MATERIALS AND METHODS: This is retrospective study of 83 patients. We performed univariate analysis for patient information, bone density, fracture configuration and screw position divided into SFNS group (n=13) and non-SFNS group (n=70) and performed multivariate analysis using logistic regression model. We also analyzed the relationship between SFNS and complications such as osteonecrosis of femoral head and nonunion. RESULTS: There was a significant difference in age, screw non-parallelism and bone mineral density of intertrochanteric and total hip area in the univariate analysis between the two groups (P < 0.05). In multivariate analysis, old age (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.03-1.21) and screw non-parallelism (OR, 2.95; 95% CI, 1.44-6.59) were significant risk factors for SFNS. The incidence of SFNS was significantly higher in the complication group (P=0.027). CONCLUSION: Bone density did not significantly affect SFNS in valgus impacted femoral neck fractures treated with three parallel screws. The risk factors of SFNS were old age and screw non-parallelism. Therefore, we recommend using other fixation method to prevent SFNS in older ages and making the screw position as parallel as possible when performing screw fixation in valgus impacted femoral neck fracture.
Bone Density* ; Femoral Neck Fractures* ; Femur Neck* ; Head ; Hip ; Humans ; Incidence ; Logistic Models ; Methods ; Multivariate Analysis ; Neck* ; Osteonecrosis ; Retrospective Studies ; Risk Factors*

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Outcomes of Cephalomedullary Nailing in Basicervical Fracture.

Seok Hyun KWEON ; Sung Hyun LEE ; Seng Hwan KOOK ; Young Chae CHOI

Hip & Pelvis.2017;29(4):270-276. doi:10.5371/hp.2017.29.4.270

PURPOSE: A basicervical femoral fracture is defined as a fracture of base of neck of femur that occurs medially from intertrochanteric line above lesser trochanter. In this study, we intended to evaluate radiological and clinical results of basicervical femoral fractures treated by intramedullary nailing. MATERIALS AND METHODS: Fifteen patients, who underwent intramedullary nailing among 50 patients, out of 50 who were diagnosed with basicervical femoral fractures from July 2012 to May 2015 were studied. All of 15 patients' fracture were two-part basicervical fractures. Using radiography, we characterized the: i) state of reduction, ii) location of the lag screw, iii) tip apex distance (TAD), and iv) sliding distance of lag screw and bone union. Additionally, we performed clinical assessment before injury and at final follow-up. RESULTS: In radiological assessment, we achieved acceptable reduction state in all patients. All lag screws were fixated on appropriate locations. Mean TAD was 17.3 mm (11.0–21.1 mm), which showed insertion point of < 25 mm in all cases. The mean sliding distance of the lag screw was 5.1 mm (0.1–16.0 mm) at the final follow-up. The mean bone union period was 4.8 months (3–10 months) with achieving in all cases. In clinical assessment, Harris hip score, visual analogue scale score and Western Ontario and McMaster Universities Arthritis Index score, all of them significantly improved postoperatively compared with preoperative scores (P < 0.05). CONCLUSION: In elderly patients with basicervical femoral fractures, treatment with intramedullary nailing showed satisfactory results, considered to be a useful method if performed with skilled technique.
Aged ; Arthritis ; Femoral Fractures ; Femur ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; Hip ; Humans ; Methods ; Neck ; Ontario ; Radiography

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Fixation of Trochanteric Fragments in Cementless Bipolar Hemiarthroplasty of Unstable Intertrochanteric Fracture: Cerclage Wiring.

Young Kyun LEE ; Chan Ho PARK ; Kyung Hoi KOO

Hip & Pelvis.2017;29(4):262-269. doi:10.5371/hp.2017.29.4.262

PURPOSE: Bipolar hemiarthroplasty (HA) is an option for the treatment of unstable intertrochanteric fracture in elderly patients. There is a raising concern regarding cable-grip related complications for the fixation of trochanteric fragments. Therefore, the aim of this study was to evaluate outcome of cementless HA with fixation for the trochanteric fragments using monofilament wires in unstable intertrochanteric fracture. MATERIALS AND METHODS: We reviewed 92 cementless bipolar HAs using a grit-blasted long stem design for unstable intertrochanteric fractures in 91 elderly patients with a mean age of 81.7 years. During the arthroplasty, trochanteric fracture fragments were fixed using 1 or 2 vertical wires and transverse wires. We evaluated the clinical outcomes such as abductor power, ambulatory ability and wire-related complications, and radiologic outcomes including the union of the trochanteric fragment and subsidence of stem. RESULTS: Sixty-two patients were followed for a minimum of 2 years (mean, 59 months) postoperatively. The mean abductor power and Koval category was 4.1 (range, 3 to 5) and 4.6 (range, 1 to 6). The wire was broken in 3 hips (4.8%) and the nonunion of the greater trochanter occurred in 1 hips (1.6%). Two stems subsided by 3 mm and 8 mm, respectively, during postoperative 6 weeks, after which the subsidence was not progressive. CONCLUSION: Cerclage wiring of the trochanter using monofilament wire leads to acceptable outcome in cementless HA for senile patients with unstable intertrochanteric fracture. Cerclage wiring using a monofilament wire is recommended for the fixation of trochanteric fragments.
Aged ; Arthroplasty ; Femur* ; Hemiarthroplasty* ; Hip ; Hip Fractures ; Humans

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Epidemiology of Pelvic Ring Fractures in a Level 1 Trauma Center in the Netherlands.

Erik HERMANS ; Jan BIERT ; Michael John Richard EDWARDS

Hip & Pelvis.2017;29(4):253-261. doi:10.5371/hp.2017.29.4.253

PURPOSE: This study was conducted to study the epidemiology, classification, treatment and outcome of a large patient group with pelvic ring injury in a level 1 trauma center in the Netherlands. MATERIALS AND METHODS: In the period of 2004 to 2014, we encountered 537 patients with a pelvic fracture. Many of them are due to a high energy trauma and therefore many concomitant injuries are observed. Tile A fractures were seen in 137 patients (25.5%), Tile B fractures in 211 (39.3%) and Tile C fractures in 189 patients (35.2%). RESULTS: Patients with unstable fracture types (Tile B1 and B3, Tile C) had significantly higher injury severity score, transfusion rates, need for laparotomy and definitive operative stabilization and complication rate. However, mortality did not differ significantly among Tile A, B or C fractures. CONCLUSION: Overall outcome was good with a mortality rate of 13.6%, which is comparable with other rAelpmorotsst. half of the patients treated could directly be dismissed to their own homes.
Classification ; Epidemiology* ; Humans ; Injury Severity Score ; Laparotomy ; Mortality ; Netherlands* ; Trauma Centers*

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Utility of Radiographs, Computed Tomography, and Three Dimensional Computed Tomography Pelvis Reconstruction for Identification of Acetabular Defects in Residency Training.

Johannes F PLATE ; John S SHIELDS ; Maxwell K LANGFITT ; Michael P BOLOGNESI ; Jason E LANG ; Thorsten M SEYLER

Hip & Pelvis.2017;29(4):247-252. doi:10.5371/hp.2017.29.4.247

PURPOSE: The Paprosky classification system of acetabular defects is complex and its reliability has been questioned. The purpose of this study was to evaluate the effectiveness of different radiologic imaging modalities in classifying acetabular defects in revision total hip arthroplasty (THA) and their value of at different levels of training. MATERIALS AND METHODS: Bone defects in 8 revision THAs were classified by 2 fellowship-trained adult reconstruction surgeons. A timed presentation with representative images for each case (X-ray, two-dimensional computed tomography [CT] and three-dimensional [3D] reconstructions) was shown to 35 residents from the first postgraduate year of training year of training (PGY-1 to PGY-5), 2 adult reconstruction fellows and 2 attending orthopaedic surgeons. The Paprosky classification of bone defects was recorded. The influence of image modality and level of training on classification were analyzed using chi-square analysis (alpha=0.05). RESULTS: Overall correct classification was 30%. The level of training had no influence on correct classification (P=0.531). Using X-ray led to 37% correctly identified defects, CT scans to 33% and 3D reconstructions to 20% of correct answers (P < 0.001). There was no difference in correct classification based defect type (P < 0.001). Regardless of level of training or imaging, 64% of observers recognized type 1 defects, compared to only 16% correct recognition of type 3B defects. CONCLUSION: Using plain X-rays led to an increased number of correct classification, while regular CT scan and 3D CT reconstructions did not improve accuracy. The classification system of acetabular defects can be used for treatment decisions; however, advanced imaging may not improve its utilization.
Acetabulum* ; Adult ; Arthroplasty, Replacement, Hip ; Classification ; Humans ; Internship and Residency* ; Pelvis* ; Reoperation ; Surgeons ; Tomography, X-Ray Computed

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Perioperative Comparison of Hip Arthroplasty Using the Direct Anterior Approach with the Posterolateral Approach.

Sang Hong LEE ; Sin Wook KANG ; Suenghwan JO

Hip & Pelvis.2017;29(4):240-246. doi:10.5371/hp.2017.29.4.240

PURPOSE: The aim of the current study is to report the advantage and disadvantage of total hip arthroplasty performed in direct anterior approach (DAA) by comparing it to the posterolateral approach (PLA). MATERIALS AND METHODS: Twenty-five hip arthroplasty done in DAA (12 total hip arthroplasty [THA] and 13 bipolar hemiarthroplasty [BHA]) were compared with the same number done in PLA (13 THA and 12 BHA). Intraoperative assessments including operation time, anesthetic time, bleeding amount were recorded with intraoperative complications. Immediate postoperatively, position of the prosthesis and leg length discrepancy were measured and were compared between the two approaches. RESULTS: The operation time was 22 minutes and 19 minutes longer in DAA for THA and BHA respectively while the anesthetic time difference was 26 and 10 respectively. However, these parameters showed no statistical difference. No significance was found when bleeding amount was compared. For DAA, cup alignment was within safe zone in 100% both for inclination and for anteversion while this was 83.3% and 75.0% respectively in PLA. Leg length difference was 3 mm in DAA and 5 mm in PLA but had no significant difference. Tensor fascia lata tear was the most common complication occurring in 9 patients. CONCLUSION: Although significant was not reached there was trend toward more operation time and anesthetic time when DAA was used. However, the trend also showed that cup and stem were likely to be in more accurate position and in adequate size which is likely due to the accurate use of fluoroscopy.
Arthroplasty* ; Arthroplasty, Replacement, Hip ; Bleeding Time ; Butylated Hydroxyanisole ; Fascia Lata ; Fluoroscopy ; Hemiarthroplasty ; Hemorrhage ; Hip* ; Humans ; Intraoperative Complications ; Leg ; Prostheses and Implants ; Tears

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Extensive Surgical Wound Lavage Reduces the Incidence and Severity of Heterotopic Ossification in Primary Total Hip Replacement: A Study of 175 Hip Replacements.

Avadhoot P KANTAK ; Nirav N SHAH

Hip & Pelvis.2017;29(4):234-239. doi:10.5371/hp.2017.29.4.234

PURPOSE: One of the local factors contributing to the formation of heterotopic ossification includes bone debris generated during the surgery. This risk can be partially nullified by use of saline wash. Our research aim was to ascertain if extensive intraoperative lavage can reduce the incidence and severity of heterotopic ossification in primary total hip arthroplasty. MATERIALS AND METHODS: A retrospective case control radiological study of 145 patients (175 hip replacements). The control group received minimal intra-operative lavage ( < 1,000 mL); consisted of 90 primary hip replacements. The index group received extensive saline lavage (>3,000 mL), and included 85 primary hip replacements. Brooker classification was used to grade radiographs at one year for development of heterotopic ossification. RESULTS: Sixty-six patients in control group had heterotopic ossification, with six showing a significant grade (grade 3 or 4). Thirty-five patients in the index group had heterotopic ossification with no incidence of severe grade. Majority patients in the index group showed a predominantly grade 1 heterotopic ossification; 28 out of 35, as compared to 37 out of 66 in control group. There was a statistically significant difference in the incidence (P < 0.05) as well as severity of heterotopic ossification between the groups (P < 0.05). CONCLUSION: We conclude that use of extensive lavage during total hip replacement reduces the incidence as well as severity of heterotopic ossification.
Arthroplasty, Replacement, Hip* ; Case-Control Studies ; Classification ; Hip* ; Humans ; Incidence* ; Ossification, Heterotopic* ; Retrospective Studies ; Therapeutic Irrigation* ; Wounds and Injuries*

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Compartment Syndrome of the Gluteus Medius Occurred without Bleeding or Trauma: A Case Report.

Gyu Min KONG ; Yong Uk KWON ; Jun Ho PARK

Hip & Pelvis.2015;27(4):278-282. doi:10.5371/hp.2015.27.4.278

Compartment syndrome is an ischemic change resulting from an increase in compartment pressure. Initially, patients present with direct tenderness and swelling, and the weak circulation secondary to compartment syndrome can eventually lead to motor and sensory impairment. If the increase in pressure results in neurological impairment, emergency intervention is required to decompress the compartment. Typically, compartment syndrome develops on forearms or lower legs. The gluteal compartment is rarely the location of compartment syndrome and only a few cases have been presented in the literature with trauma or hematoma. We have treated a patient with gluteal compartment syndrome who presented with no history of trauma or hemorrhage and present that case report here.
Compartment Syndromes* ; Emergencies ; Forearm ; Hematoma ; Hemorrhage* ; Humans ; Leg

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