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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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Bilateral Bone Marrow Edema Syndrome of the Femoral Head with a Unique Onset: A Case Report.

Seung Rim YI ; Ye Hyun LEE ; Hae Min KIM

Hip & Pelvis.2015;27(4):273-277. doi:10.5371/hp.2015.27.4.273

Bone marrow edema syndrome (BMES) is a rare condition which mainly affects the hip area. The etiology and pathogenesis of BMES is still unclear. Pain near the affected area, regional osteoporosis, bone marrow edema (identified using magnetic resonance imaging) and spontaneous regression within 6-12 months are the main characteristics of BMES. In this case, a 52-year-old male was diagnosed with BMES of the right hip followed by spontaneous subsiding of symptoms. After 3 years, and under nearly the same social and physical conditions, he was admitted again with newly developed left hip pain and again diagnosed with BMES. We report this rare case since a similar one has not been previously reported in the domestic literature and may be considered valuable for basic research relating to the pathogenesis of BMES.
Bone Marrow* ; Edema* ; Femur Head ; Head* ; Hip ; Humans ; Male ; Middle Aged ; Osteoporosis

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Characterizing the Progression of Varying Types of Calcific Tendinitis around Hip.

Seung Rim YI ; Min Ho LEE ; Bo Kyu YANG ; Young Joon AHN ; Jieun KWON ; Se Hyuk IM ; Ye Hyun LEE

Hip & Pelvis.2015;27(4):265-272. doi:10.5371/hp.2015.27.4.265

PURPOSE: To assess the progression of clinical symptoms and disease course of calcific tendinitis in the hip region according to types of calcification. MATERIALS AND METHODS: Among patients with the hip pain, 28 patients (21 males and 7 females; mean age 51 years, range 32-74 years) showing calcified lesions in simple radiography without other possible sources of pain were analyzed retrospectively. Twelve patients displayed a symptom duration of less than three weeks (acute; average=1+/-0.9 week) and 16 displayed greater than three weeks (chronic; average=21.0+/-19.5 weeks). Lesions were classified as nodular (11, 39.3%), nodular-fragmented (13, 46.4%), or amorphous (4, 14.3%). Initial symptoms, progression of clinical features, radiological findings and prognosis were investigated and analyzed according to calcification type. RESULTS: In 15 patients (53.6%), lesions were located superior to the great trochanter. On average, the acute group was younger (44.58 vs. 55.44 years, P=0.006), suffered more (mean pain Numeric Rating Scale [NRS], 6.3 vs. 3.8; P<0.001), and recovered more (difference between initial and follow-up NRS, 5.1 vs. 2.63; <<0.001) than the chronic group. The mean length of initial lesions was longer in the acute group than the chronic group (15.8 vs. 9.1 mm, P=0.008). When compared to patients with distinctive margins (15, 53.6%), those with nondistinctive margins showed better improvement (difference between initial and follow-up NRS, 4.7 vs. 2.8; P=0.01) and more significant decrease in lesion size (difference between initial and follow-up length, 10.8 vs. 2.6 mm; P=0.003). CONCLUSION: Calcific tendinitis occurring in the hip area displayed a variety of characteristics. Although complaining of more severe pain in the initial phase, patients with acute pain or calcific lesions with nondistinctive margins showed better symptom improvement when compared to their counterparts.
Acute Pain ; Female ; Femur ; Follow-Up Studies ; Hip* ; Humans ; Male ; Prognosis ; Radiography ; Retrospective Studies ; Tendinopathy*

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Does the Time of Postoperative Bisphosphonate Administration Affect the Bone Union in Osteoporotic Intertrochanteric Fracture of Femur?.

Yoon Je CHO ; Young Soo CHUN ; Kee Hyung RHYU ; Joon Soon KANG ; Gwang Young JUNG ; Jun Hee LEE

Hip & Pelvis.2015;27(4):258-264. doi:10.5371/hp.2015.27.4.258

PURPOSE: This study was designed to investigate the effect of bisphosphonate administration starting time on bone healing and to identify the best administration time following surgical treatment of osteoporotic intertrochanteric fractures. MATERIALS AND METHODS: Two hundreds and eighty four patients (284 hips; 52 males, 232 females) who underwent surgery following osteoporotic intertrochanteric fracture from December 2002 to December 2012 were retrospectively analyzed. The average follow-up period was 68.4 months. The patients were divided into three groups according to the time of bisphosphonate administration after operation: 1 week (group A; n=102), 1 month (group B; n=89), and 3 months (group C; n=93). Koval scores and change of Koval scores 1 year after operation were used for clinical evaluation. For radiologic evaluation, the time of callus appearance across the fracture line on sagittal and coronal radiographs and the time to absence of pain during hip motion was judged as the time of bone union. RESULTS: Koval scores one year after surgery for groups A, B, and C were 2.44, 2.36, and 2.43 (P=0.895), respectively. The mean time of union was 12.4, 11.9, and 12.3 weeks after operation in the three groups (P=0.883), respectively. There were zero cases of nonunion. There were 3, 5, and 7 cases of fixative displacement in the three groups, respectively, but the distribution showed no significant difference (P>0.472). CONCLUSION: The initiating time of bisphosphonate administration following surgery does not affect the clinical outcomes in patients with osteoporotic intertrochanteric fracture.
Bony Callus ; Diphosphonates ; Femur* ; Follow-Up Studies ; Hip ; Hip Fractures ; Humans ; Male ; Osteoporotic Fractures ; Retrospective Studies

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Osteonecrosis of Femoral Head Treated with Extracorporeal Shock Wave Therapy: Analysis of Short-term Clinical Outcomes of Treatment with Radiologic Staging.

Jin Young LEE ; Jae Woo KWON ; Jung Seob PARK ; Kyeol HAN ; Woo Jin SHIN ; Jeong Gil LEE ; Byung Hoon LEE

Hip & Pelvis.2015;27(4):250-257. doi:10.5371/hp.2015.27.4.250

PURPOSE: To evaluate clinical results of extracorporeal shock wave therapy (ESWT) with radiographic staging on patients with avascular necrosis of femoral head (AVNFH). MATERIALS AND METHODS: We evaluated 24 patients diagnosed with AVNFH (32 hip joints) who were treated with ESWT from 1993 to 2012. Average follow-up period was 27 months, and the average age of patients was 47.8 years. The Association Research Circulation Osseous (ARCO) system was used to grade radiographic stage prior to treatment. For this study patients were divided into two groups based on their ARCO stage, group 1 (ARCO stages I and II) and group 2 (ARCO stage III). Comparative analyses were done between the two groups using the visual analogue scale (VAS) score and the Harris hip score (HHS) at pre-treatment and 3, 6, 12, and 24 months after treatment. Failure was defined when radiographic stage progressed or arthroplasty surgery was needed due to clinical exacerbation. RESULTS: Both groups showed clinical improvements with VAS scoring at final follow-up (group 1: median 7 to 1.5, P<0.001; group 2: mean 7 to 4, P=0.056). Using HHS, group 1 showed a significant improvement (from 65.5 to 95 [P<0.001]), while no significance was observed for group 2 (P=0.280). At final follow-up, 3 hips from group 1 and one hip from group 2 showed radiographic improvement; however, two patients underwent total hip arthroplasty due to persistent pain and dysfunction. CONCLUSION: ESWT can be considered as an interventional option before surgical treatment in patients with not only early stage AVNFH but also with mid stage.
Arthroplasty ; Arthroplasty, Replacement, Hip ; Follow-Up Studies ; Head* ; Hip ; Humans ; Necrosis ; Osteonecrosis* ; Shock*

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Open Surgical Treatment for Femoroacetabular Impingement in Patients over Thirty Years: Two Years Follow-up Results.

Su Hyun CHO

Hip & Pelvis.2015;27(4):241-249. doi:10.5371/hp.2015.27.4.241

PURPOSE: We report short term results of open surgical treatment for symptomatic femoroacetabular impingement (FAI) in patients over the age of 30 years. MATERIALS AND METHODS: Between May 2011 and June 2012, thirteen FAI hips (11 patients) with hip pain persisting longer than 6 months were treated by either surgical hip dislocation (SHD) or anterior mini-open. They were followed up for longer than 2 years. The 11 patients included 7 females and 4 males with a mean age of 45 (range, 33-60) years. They were clinically evaluated for modified Harris hip score (MHHS) and University of California at Los Angeles (UCLA) activity level. Their lateral center-edge angle, acetabular index, and alpha angle were measured and compared. RESULTS: Acetabuloplasties were performed for seven cases. Femoral osteochondroplasty was performed for all thirteen cases. At minimum follow-up of two year (range, 24-29 months), all patients had substantial relief in preoperative pain with improvement in range of motion. The median MHHS was significantly (P<0.05) improved from 61 points preoperatively to 87 points at the last follow-up. The median UCLA activity level was 7 (range, 5-8) at last follow-up. Radiological indices improved. Two cases showed mild residual pain attributable to adhesion between capsule and reshaped femoral head-neck area. CONCLUSION: Open surgical treatment of FAI was a reliable and effective treatment method in symptomatic FAIs for patients over the age of 30 years without advanced arthritic change of hip joint at short term follow-up.
Acetabulum ; California ; Female ; Femoracetabular Impingement* ; Follow-Up Studies* ; Hip ; Hip Dislocation ; Hip Joint ; Humans ; Male ; Range of Motion, Articular

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Bipolar Hemarthroplasty Using Cementless Conical Stem for Treatment of Dorr Type B and C Femoral Neck Fracture.

Jeong Hoon KANG ; Sang Hong LEE ; Sung JUNG

Hip & Pelvis.2015;27(4):232-240. doi:10.5371/hp.2015.27.4.232

PURPOSE: The current study aims to evaluate the clinical and the radiological outcome of bipolar hemiarthroplasty using cementless cone stem to treat osteoporotic femoral neck fracture and compare the results according to the proximal femur geometry. MATERIALS AND METHODS: Seventy-five hips (75 patients) that underwent bipolar hemiarthroplasty with cementless cone stem between September 2006 and December 2011 were analyzed. The minimum follow-up period was 3 years. Thirty-three hips were classified as type B and 41 as type C. The clinical outcome was assessed using Harris hip score and the walking ability score. Radiographic evaluation was performed to evaluate the stability of the prosthesis. RESULTS: At the most recent follow up, the mean Harris hip score was 86 (range, 70-92) and 65% recovered to preoperative ambulatory status. In the radiographic exam, stable stem fixation was achieved in all cases. For the complications, eight hips developed deep vein thrombosis while three hips showed heterotopic ossification. Dislocation and delayed deep infection occurred in one hip resepectively. There were no significance differences in Harris hip score and walking ability score when the type B group was compare with the type C. CONCLUSION: Bipolar hemiarthroplasty with cementless cone stem showed an excellent early outcome both clinically and radiographically regardless of the shape of the proximal femur. We believe this prosthesis can provide early stability to the Dorr type B and C femur and is an effective treatment for treating osteoporotic femoral neck fracture.
Dislocations ; Femoral Neck Fractures* ; Femur ; Femur Neck* ; Follow-Up Studies ; Hemiarthroplasty ; Hip ; Ossification, Heterotopic ; Prostheses and Implants ; Venous Thrombosis ; Walking

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Cementless Revision Total Hip Arthroplasty with Ceramic Articulation.

Jong Hyuck YANG ; Seong Jo YANG ; Joon Soon KANG ; Kyoung Ho MOON

Hip & Pelvis.2015;27(4):223-231. doi:10.5371/hp.2015.27.4.223

PURPOSE: The results of ceramic-on-ceramic (CoC) bearing surfaces in primary total hip arthroplasty (THA) were well known. However, it was not known in revision THA. The purpose of this study is to report the results of revision THA with ceramic articulation. MATERIALS AND METHODS: A total of 112 revision THAs were evaluated. The mean age at the time of surgery was 51.6 years (27.7 to 84.2 years). The mean duration of the follow-up periods was 6.3 years (2.3 to 11.4 years). RESULTS: The Harris hip scores improved from an average of 56.2 at the index surgery to an average of 93.3 at the last follow-up (P<0.001). None of hips showed osteolysis or ceramic head fracture. One hip showed aseptic loosening in the acetabular component with squeaking that caused a re-revision. There were nine cases of dislocation. The survivorship at 5 years was 94.5% (95% confidence interval, 87.9% to 97.6%) with revision for any reason as the endpoint and 100% with femoral revision. CONCLUSION: The ceramic articulation is one of good bearing options for revision THA in patients with a long life expectancy.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Ceramics* ; Dislocations ; Follow-Up Studies ; Head ; Hip ; Humans ; Life Expectancy ; Osteolysis ; Survival Rate

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Total Hip Arthroplasty Using Metal Head on a Highly Cross-linked Polyethylene Liner.

Min Yook KIM ; Young Yool CHUNG ; Ji Hoon PARK ; Jung Ho LEE

Hip & Pelvis.2015;27(4):216-222. doi:10.5371/hp.2015.27.4.216

PURPOSE: This retrospective study was performed to evaluate the clinical results and measure polyethylene liner wear in total hip arthroplasty (THA) with highly cross-linked polyethylene. MATERIALS AND METHODS: Except for patients who had died or were unable to have follow-up at least 2 years, 60 of 78 hips that underwent THA were included this study. The mean age was 64.5 years (range, 25-81 years) and the mean body mass index (BMI) was 23.0 kg/m2 (18.1-32.3 kg/m2). Diagnosis at the time of the operation was osteonecrois of the femoral head in 28 hips, primary osteoarthritis in 14, hip fracture in 13, and other diseases in 5. The mean follow-up period was 3.8 years (2.1-7.1 years). Harris hip score (HHS) was reviewed before THA and at the last follow-up. On the anteroposterior pelvic radiographs, acetabular cup inclination and ante-version were also measured. The annual linear wear rate was measured using Livermore's method on the radiographs. RESULTS: The mean HHS was 60.1 (28-94) before operation and 90.4 (47-100) at the last follow-up. In the immediate post-operation, the average inclination and anteversion angles of the acetabular cups were 46.3degrees (standard deviation, +/-6.7degrees) and, 21.4degrees(+/-10.1degrees) respectively. The mean of the annual linear polyethylene wear was 0.079 mm/year (0.001-0.291 mm/year). Age, gender and BMI were not statistically related to linear polyethylene wear but the period of follow-up and the acetabular cup's inclination showed significant negative and positive correlation respectively. CONCLUSION: The wear rate of a highly cross-linked polyethylene was shown to correlate negatively with duration of follow-up. However, our study was based on a short-term follow-up, so a long-term follow-up study is necessary in the future.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Body Mass Index ; Diagnosis ; Follow-Up Studies ; Head* ; Hip ; Humans ; Osteoarthritis ; Polyethylene* ; Retrospective Studies

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The Results of Long-term Follow-up of Total Hip Arthroplasty Using Hydroxyapatite-coated Cups.

Chang Dong HAN ; Keun Young SHIN ; Hyun Hee LEE ; Kwan Kyu PARK ; Ick Hwan YANG ; Woo Suk LEE

Hip & Pelvis.2015;27(4):209-215. doi:10.5371/hp.2015.27.4.209

PURPOSE: The aim of this study was to report the long-term outcome and the failure mechanism of cementless total hip arthroplasty (THA) using hydroxyapatite (HA)-coated acetabular cup. MATERIALS AND METHODS: From January 1992 to May 1994, a total of 123 consecutive cementless primary THAs were performed using a HA-coated acetabular cup with metal-on-polyethylene articulation. We retrospectively evaluated 66 hips available for follow-up at a mean 18.3 years (range, 10.4-23.6 years). The survival analysis was performed by the Kaplan-Meier method. We defined end point as any failure that required a reoperation of acetabular component. RESULTS: Thirty-nine of 66 hips (59.1%) were defined as a failure for progressive acetabular osteolysis or aseptic loosening of the cup. Acetabular osteolysis was observed in 47 hips (71.2%) and 33 hips (50.0%) were revised because of cup loosening. The Kaplan-Meier method showed the survival rate of the acetabular cup to be 46.3% at 15 years and 34.8% at 20 years for any failure that required a reoperation of acetabular component. CONCLUSION: The long-term survival rate of THA using HA-coated acetabular cup was unsatisfactory, and it was attributed to vulnerable property of HA coating and progressive osteolysis.
Acetabulum ; Arthroplasty, Replacement, Hip* ; Durapatite ; Follow-Up Studies* ; Hip ; Osteolysis ; Reoperation ; Retrospective Studies ; Survival Rate

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