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Surgical Site Infection Following Fixation of Acetabular Fractures.

Faizan IQBAL ; Sajid YOUNUS ; ASMATULLAH ; Osama Bin ZIA ; Naveed KHAN

Hip & Pelvis.2017;29(3):176-181. doi:10.5371/hp.2017.29.3.176

PURPOSE: Acetabular fractures are mainly caused by high energy trauma. Surgical fixation of these fractures requires extensive surgical exposure which increases the length of operation and blood loss as well. This may increase the risk of surgical site infection. Our aim is to evaluate the prevalence of surgical site infections and the risk factors associated with it so as to minimize its chances. MATERIALS AND METHODS: A total of 261 patients who underwent acetabular fracture surgery were retrospectively reviewed. Patients were divided into 2 groups, with or without surgical site infection. Factors examined include patients' gender, age, body mass index (BMI), time between injury and surgery, operative time, estimated blood loss, number of packed red blood cell transfused, length of total intensive care unit (ICU) stay, fracture type, surgical approach, smoking status, patients' comorbids and associated injuries. RESULTS: Fourteen patients (5.4%) developed surgical site infection. Out of 14 infections, 4 were superficial and 10 were deep. The factors that were found to be associated with surgical site infection following acetabular fracture fixation were prolonged operation time, increased BMI, prolonged ICU stay, larger amount of packed red blood cell transfused and associated genitourinary and abdominal trauma. CONCLUSION: In our study, we conclude that measures should be undertaken to attenuate the chances of surgical site infection in this major surgery by considering the risk factors significantly associated with it.
Acetabulum* ; Body Mass Index ; Erythrocytes ; Fracture Fixation ; Humans ; Intensive Care Units ; Operative Time ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Surgical Wound Infection*

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Acetabular Defect Reconstruction with Trabecular Metal Augments: Study with Minimum One-year Follow-up.

Chirayu DWIVEDI ; Sandeep GOKHALE ; Hyun Gon KHIM ; Jeon Keon OH ; Won Yong SHON

Hip & Pelvis.2017;29(3):168-175. doi:10.5371/hp.2017.29.3.168

PURPOSE: High rates of mechanical failure have been reported in type III acetabular defects. Recently porous trabecular metal augments have been introduced with, excellent biomechanical characteristics and biocompatibility, allowing early stability and greater bone ingrowth. The aim of the study was to assess the short term clinical and radiological outcome of the trabecular metal augments. MATERIALS AND METHODS: We performed, 22 revision total hip arthroplasties (THA) and 6 primary THA (total 28) using trabecular metal augments to reconstruct acetabular defect between 2011 to 2015. Among 28 patients, 18 were males, 10 females. Mean age of patients was 61.21 years. Paprosky classification for acetabular bone defects was used. Eighteen cases were classified as grade 3 A and 10 cases as grade 3B. Hip center was calculated in each case preoperatively and compared postoperatively to check whether it has been brought down. Clinical outcome assessed using Harris hip score (HHS) and radiological outcomes as osteolysis in acetabular zones and osseointegration, according to Moore's criteria. RESULTS: HHS improved from 58.00 to 86.20. Centre of rotation of hip joint corrected from 38.90 mm preoperatively to 23.85 mm postoperatively above the interteardrop line. Among 28 patients, 18 patients had three or more signs of osseointegration (Moore's criteria), during final follow up and 10 had one/two signs. No radiolucency, osteolysis, or loosening found during follow up radiographic examination. CONCLUSION: Our study showed that trabecular metal augments were highly satisfactory in short term. However, long term study is required for better evaluation.
Acetabulum* ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Classification ; Female ; Follow-Up Studies* ; Hip ; Hip Joint ; Humans ; Male ; Osseointegration ; Osteolysis

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Recent Updates of the Diagnosis and Prevention of Venous Thromboembolism in Patients with a Hip Fracture.

Won Chul SHIN ; Sang Min LEE ; Kuen Tak SUH

Hip & Pelvis.2017;29(3):159-167. doi:10.5371/hp.2017.29.3.159

Venous thromboembolism (VTE) is a potentially fatal complication that is relatively common after hip surgery. Since patients with a hip fracture have a higher risk of preoperative VTE due to an inability to ambulate after injury and aggravation of underlying age-related conditions, it may be difficult to effectively prevent VTE using only conventional approaches. Very few studies have been published reporting on the prevalence and prevention of VTE in patients with a hip fracture compared to those with hip arthroplasty. For this reason, we aimed to share recent updates on the diagnosis and prevention of VTE in patients with a hip fracture. Preoperative screening tests to diagnose VTE need to be performed more actively following hip fracture and indirect multidetector computed tomography venography is considered the most effective test for this purpose. As the risk of VTE appears to increase with time following a hip fracture, preventive measures should be taken as soon as possible in patients with a hip fracture. A wide variety of mechanical and pharmacological options are available for prophylaxis. When considering patient compliance and preventive impact, intermittent pneumatic compression devices and foot pumps are recommended as mechanical modalities. Of the available preventive medications for patients with a hip fracture, low molecular weight heparin seems to be the most appropriate option because of its short half-life and fast onset of action. Surgery should be performed as soon as possible in patients with hip fractures, and we recommend mechanical and pharmacological methods as active interventions immediately after injury to prevent VTE.
Arthroplasty ; Diagnosis* ; Foot ; Half-Life ; Heparin, Low-Molecular-Weight ; Hip Fractures ; Hip* ; Humans ; Intermittent Pneumatic Compression Devices ; Mass Screening ; Multidetector Computed Tomography ; Patient Compliance ; Phlebography ; Prevalence ; Venous Thromboembolism*

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Acetabular Cup Revision.

Young Ho KIM

Hip & Pelvis.2017;29(3):155-158. doi:10.5371/hp.2017.29.3.155

The use of acetabular cup revision arthroplasty is on the rise as demands for total hip arthroplasty, improved life expectancies, and the need for individual activity increase. For an acetabular cup revision to be successful, the cup should gain stable fixation within the remaining supportive bone of the acetabulum. Since the patient's remaining supportive acetabular bone stock plays an important role in the success of revision, accurate classification of the degree of acetabular bone defect is necessary. The Paprosky classification system is most commonly used when determining the location and degree of acetabular bone loss. Common treatment options include: acetabular liner exchange, high hip center, oblong cup, trabecular metal cup with augment, bipolar cup, bulk structural graft, cemented cup, uncemented cup including jumbo cup, acetabular reinforcement device (cage), trabecular metal cup cage. The optimal treatment option is dependent upon the degree of the discontinuity, the amount of available bone stock and the likelihood of achieving stable fixation upon supportive host bone. To achieve successful acetabular cup revision, accurate evaluation of bone defect preoperatively and intraoperatively, proper choice of method of acetabular revision according to the evaluation of acetabular bone deficiency, proper technique to get primary stability of implant such as precise grafting technique, and stable fixation of implant are mandatory.
Acetabulum* ; Arthroplasty ; Arthroplasty, Replacement, Hip ; Classification ; Hip ; Hip Prosthesis ; Life Expectancy ; Methods ; Reoperation ; Transplants

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Aspergillus Septic Arthritis of the Hip in an Immunocompetent Middle-aged Female with Undiagnosed Recurrent Pulmonary Aspergillosis.

Pil Whan YOON ; Joo Ho SONG ; Kang Sup YOON ; Jae Suk CHANG ; Hee Joong KIM ; Kee Hyung RHYU

Hip & Pelvis.2015;27(3):196-200. doi:10.5371/hp.2015.27.3.196

We present a case of Aspergillus septic hip arthritis in an immunocompetent patient with undiagnosed recurrent pulmonary aspergillosis who underwent arthroscopic surgery. Biopsy specimens of synovium revealed fungal hyphae, confirming Aspergillus infection. Aspergillus septic hip arthritis can occur in immunocompetent patients, and arthroscopy can be a noninvasive surgical option in these cases.
Arthritis ; Arthritis, Infectious* ; Arthroscopy ; Aspergillus* ; Biopsy ; Female* ; Hip* ; Humans ; Hyphae ; Pulmonary Aspergillosis* ; Synovial Membrane

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A Liner Breakage in Total Hip Arthroplasty after Using 1st Generation Highly Cross Linked Polyethylene Mated against 36-mm Metal Head: A Case Report.

Won Kee CHOI ; Myung Rae CHO ; Seung Bum CHAE ; Dong Young KIM

Hip & Pelvis.2015;27(3):192-195. doi:10.5371/hp.2015.27.3.192

It has been known the highly cross linked polyethylene (HXLPE) has an advantage of improved wear rate. However, the alteration in mechanical properties such as decreased tensile yield and fatigue strength make concerns about fragility of HXLPE. We experienced a case of HXLPE breakage. But, this case of liner breakage happened although patient belonged to normal BMI and proper acetabular cup position so called "safe zone" on radiographs. So, we report this case with reference review.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Fatigue ; Head* ; Humans ; Polyethylene*

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Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases.

Kyung Jae LEE ; Byung Woo MIN ; Hyung Kyu JANG ; Hee Uk YE ; Kyung Hwan LIM

Hip & Pelvis.2015;27(3):187-191. doi:10.5371/hp.2015.27.3.187

Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature.
Arthroplasty* ; Femoral Fractures ; Femur ; Hip* ; Humans ; Periprosthetic Fractures

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Periprosthetic Insufficiency Fracture around Radiographically Loose Cemented Stem: A Report of Two Cases.

Young Soo CHUN ; Jung Suk LEE ; Yoon Je CHO ; Kee Hyung RHYU

Hip & Pelvis.2015;27(3):183-186. doi:10.5371/hp.2015.27.3.183

As the osteoporotic patient population grows, various periprosthetic fractures that cannot be classified appropriately can occur around the femur after hip arthroplasty. We experienced two cases of periprosthetic insufficiency fractures at subtrochanteric area of the femurs around radiographically loose cemented femoral stems. The ages of the patients were 75 years and 83 years. Both patients could not recall any history of trauma before the onset of pain. Both were treated non-operatively. Both healed uneventfully and did not recur after two years of follow up. When the osteoporotic patient with cemented stem showed sudden hip or thigh pain without a history of trauma, great attention should be focused to find this lesion.
Arthroplasty ; Femur ; Follow-Up Studies ; Fractures, Stress* ; Hip ; Humans ; Periprosthetic Fractures ; Thigh

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Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report.

Young Soo CHUN ; Hyung Suk JUH ; Yoon Je CHO ; Kee Hyung RHYU

Hip & Pelvis.2015;27(3):179-182. doi:10.5371/hp.2015.27.3.179

Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.
Arthroplasty ; Arthroplasty, Replacement, Hip* ; Femur ; Hip ; Humans ; Risk Factors

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Ischial Tuberosity Avulsion Stress Fracture after Short Period of Repetitive Training.

Bo Kyu YANG ; Seung Rim YI ; Young Joon AHN ; Se Hyuk IM ; Sang Hyun PARK

Hip & Pelvis.2016;28(3):187-190. doi:10.5371/hp.2016.28.3.187

Fatigue fracture of the pelvis is the form of fracture due to repetitive micro-stress accumulation, can be affected by a number of factors such as patient's nutritional status, biomechanics, social status and so on. Still there is no study about precise standard degree of external force that lead to stress fracture, but it may caused by compression force, traction force or complex force and others. Avulsion stress to ischial tuberosity or anterior superior iliac spine by attached muscle is known as the main factor for the avulsion fracture. This report will deal with 19 years old conscripted policeman who occurred ischial tuberosity avulsion fracture after training of 6-hour running for 5 days accompanying hip hyper-flexion motion. This reports aims to provide case study of stress fracture occurred after 5 days of exercise which is relatively short period who had no specific trauma history or pain.
Fractures, Stress* ; Hip ; Ischium ; Nutritional Status ; Pelvis ; Running ; Spine ; Traction

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