PURPOSE: Over 30,000 hip hemiarthroplasties for neck of femur fractures are performed annually in the United Kingdom (UK). The national recommendation is via the lateral approach, to reduce the risk of dislocation, with the potential expense of reduced function and mobility post-operatively. Muscle-sparing approaches, such as SPAIRE (sparing piriformis and internus repairing externus), have been invented to address the issue of dislocation. METHODS: We performed a retrospective data collection at a single center with a high annual volume of hip hemiarthroplasties over 12 months. All patients who had hip hemiarthroplasty as their primary treatment were included. Patients who passed away and were non-ambulant before their surgery were excluded from the study. Our primary outcome was the dislocation rate and secondary outcomes were the time to mobilization after surgery and the duration of surgery. Statistical analysis was performed using XLSTAT software. RESULTS: We identified 194 cases, and these were divided into 3 groups based on the surgical approach: SPAIRE (n = 43), lateral (n = 97), and posterior (n = 54). Groups had similar demographics and a minimum 3-month follow-up after surgery. There were no dislocations in the SPAIRE group, whereas the dislocation rate for the other 2 groups was 2.5% in the lateral and 9.1% in the posterior groups at 6 months post-surgery. There was an earlier return to mobility in the SPAIRE (1.4 day) compared to the 2 other groups ( 2 days and 2.6 days). Average surgical times were very similar among all 3 groups (74 min vs. 79 min vs. 71 min). CONCLUSION The SPAIRE approach seems to be safe and provides a low risk of dislocation and good post-operative function for patients undergoing hip hemiarthroplasties.
Humans ; Hemiarthroplasty/methods* ; Retrospective Studies ; Female ; Male ; Aged ; United Kingdom ; Femoral Neck Fractures/surgery* ; Middle Aged ; Treatment Outcome ; Aged, 80 and over ; Arthroplasty, Replacement, Hip/methods* ; Trauma Centers ; Hip Dislocation/prevention & control* ; Postoperative Complications/prevention & control*

OBJECTIVETo evaluate the clinical effects of total hip arthroplasty (THA) for Crowe type IV developmental dysplasia of the hip (DDH) and analyze perioperative complications.

METHODSFrom March 2000 to March 2010, 19 patients (23 hips, of them, 4 patients with bilateral hips) with Crowe type IV DDH underwent THA. There were 5 males and 14 females, with average age of 61.3 years (ranged, 41 to 72 years). All hips were treated with small acetabular components combined with medial protrusion technique in acetabular reconstruction, as well as subtrochanteric shortening osteotomy in femur. Joint function of hips were evaluated according to Harris scoring.

RESULTSAll patients were followed up with an average of 4.2 years (ranged, 1 to 8 years). Postoperative X-ray films showed all acetabular prosthesis were in true acetabulum. No loosening and nonunion were found in all patients. Harris scoring improved from preoperative 34.0 +/- 6.9 to postoperative 85.0 +/- 7.5. Complications occurred in 11 cases in the patients, including femoral split fracture in 3 cases, nerve injury in 3 cases, delayed union in 2 cases, dislocation in 3 cases.

CONCLUSIONTotal hip arthroplasty using small acetabular component, medial protrusion, femoral subtrochanteric shortening osteotomy technique for the Crowe type IV DDH can effectively restore hip function and leg length. But incidence of complications is high. The long-term follow-up is necessary for further study.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; surgery ; Humans ; Incidence ; Joint Dislocations ; etiology ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; prevention & control

Adult ; Aged ; Female ; Femur Head ; injuries ; Hip Dislocation ; complications ; Hip Fractures ; complications ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; prevention & control

OBJECTIVETo explore the effect of improved EPSTR on prevention of dislocation after total hip arthroplasty.

METHODSFrom January 2006 to May 2007, the posterior structures were repaired using improved EPSTR in 85 cases (87 hips) of total hip arthroplasty, which involved 39 males and 46 females, with an average age of 69.5 years (range, from 62 to 85 years). Fifty-eight cases were of fresh femoral neck fracture, 25 cases were of aseptic necrosis of femoral head, 3 cases were of osteoarthritis, 1 case was of a internal fixation failure of femoral intertrochanteric fracture.

RESULTSAll 85 cases were followed up for 8-24 months (average 15 months). None of these 85 patients had posterior dislocation, external rotation contracture and greater trochanter fracture. The Harris score at the 6th month postoperatively was 89.2 +/- 4.5.

CONCLUSIONImproved EPSTR is an effective, simple and timesaving method in prevention of dislocation after total hip arthroplasty, it has clinical application value.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; adverse effects ; Female ; Femoral Neck Fractures ; surgery ; Femur Head Necrosis ; surgery ; Hip Dislocation ; prevention & control ; Hip Prosthesis ; Humans ; Male ; Middle Aged ; Osteoarthritis ; surgery ; Prosthesis Failure ; Treatment Outcome

OBJECTIVETo explore the role of reconstruction of the posterior capsule and external rotators in prevention of postoperative dislocation in total hip arthroplasty revision following the posterolateral approach.

METHODSForty-five patients (47 hips) with the mean age of 65 years (55 to 78 years)of failed total hip arthroplasty were revised following the posterolateral approach. Posterior capsule was sutured to the anterosuperior portion of the capsule from where it had been detached, and the external rotators were then reattached to the soft tissue at the tip of the greater trochanter using 1.0 silk suture in surgery. The dislocation rate and risk factors were reviewed retrospectively to determine if closing the posterior capsule resulted in fewer dislocations. The femoral prosthesis and acetabular prosthesis were revised in 29 patients (31 hips), the liner was exchanged in 5 patients (5 hips), and the acetabular prosthesis or femoral components were revised in 10 patients (10 hips) and one patient (one hip) respectively. The procedure was the patient's first revision in 29 patients (30 hips), the second revision in 15 patients (16 hips), and the third revision in one patient(one hip). Radiographic evaluation included lower limb discrepancy, acetabular phase, femoral offset, anteversion angle, prosthetic loosening before and after revision. Function evaluation based on Harris score system.

RESULTSAll patients were followed up with an average of 2.7 years. None of the patients sustained dislocation or infection, except one patient felt the anterior instability but without dislocation, X-ray revealed the acetabular component was in excessively anteversion. Lower leg discrepancy, acetabular abduction, anteversion femoral offest and collodiaphyseal angle were restored to normal level after operation on the basis of X-ray. One of the acetabular components and one of the femoral components were loose without dislocation. The Harris hip score improved from (49.13 +/- 15.53) points preoperatively to (83.59 +/- 6.93) points at the final follow-up (P < 0.05). According to Harris functional evaluation, 36 hip got an excellent result, 5 good, 5 fair and 1 bad.

CONCLUSIONThe historically high dislocation rate with the posterolateral approach for total hip arthroplasty revision can be reduced by careful soft tissue balancing,correction of implant alignment, meticulously closure of the posterior capsule, and reattaching the external rotators.

Aged ; Arthroplasty, Replacement, Hip ; instrumentation ; Female ; Follow-Up Studies ; Hip ; diagnostic imaging ; surgery ; Hip Dislocation ; prevention & control ; Hip Prosthesis ; adverse effects ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Prosthesis Failure ; Radiography ; Retrospective Studies

OBJECTIVETo assess clinical result of soft tissue balancing in primary total hip arthroplasty for severe developmental dysplasia of the hip in adults.

METHODSFrom December 2000 to August 2006, 26 primary cementless total hip arthroplasties combined with soft tissue balancing were performed in 21 cases for the treatment of severe developmental dysplasia of the hip. Patients were classified as type III (20 hips) and type IV (6 hips) according to Crowe classification. All acetabular cups were placed in their original anatomic location by soft tissue releasing and subtrochanteric shortening osteotomy. Thereafter, postoperative clinical and radiological results were evaluated.

RESULTSThe mean length of follow-up was 4.8 years (range, 13 months-7 years). Limp improved by at least one grade in 62% of the cases. Leg-length discrepancy was corrected significantly and osteotomy was undertaken in 13 hips with a mean decrease length of 0.9 cm by effective releasing. Harris scores improved significantly from a mean of 41.2 preoperatively to 89.6 postoperatively. No dislocations, infections and prosthesis loosening were found at the final follow-up evaluation.

CONCLUSIONSoft tissue balancing in total hip arthroplasty can facilitate acetabular reconstruction to normalize the hip center in severe developmental dysplasia of the hip, as a result, satisfactory short-term result can be obtained by restoring normal function and anatomic structure.

Adult ; Aged ; Arthroplasty, Replacement, Hip ; methods ; Connective Tissue ; surgery ; Female ; Follow-Up Studies ; Hip Dislocation, Congenital ; surgery ; Humans ; Male ; Middle Aged ; Osteotomy ; adverse effects ; Postoperative Complications ; prevention & control ; Treatment Outcome