Search

Objective: In developmental dysplasia of the hip (DDH), concentric reduction of dislocated hips cannot be achieved by closed reduction in many cases, and open reduction is required ('failure of reduction'). The incidence of cases requiring open reduction and the significance of risk factors for unsuccessful reduction remain unclear. We investigated the overall rate and the risk factors for failed closed reduction in DDH., Methods: We followed the Cochrane recommendations in our systematic review and meta-analysis. We performed a systematic search in three medical databases to identify all studies reporting on pediatric patients with hip dislocation in DDH on 2 July 2022. Eligible studies reported on the rate of failure in children younger than 36 months. We calculated odds ratios (ORs) with 95% CIs from two-by-two tables (event rate in risk group, event rate in non-risk group)., Results: We identified 13 316 studies and included 62 studies (5281 hips) for failure rate and 34 studies (3810 hips) for risk factor analysis. The overall rate of failure in closed reduction was 20%. The risk of failure of reduction increased with the grade of dislocation and was significantly higher for high dislocations (group 0-24: IHDI 4 vs IHDI 2 OR: 17.45, CI: 9.26-32.92; Tönnis 4 vs Tönnis 2 OR: 14.67, CI: 1.21-177.37; Graf IV vs Graf III OR: 3.4, CI: 2.27-5.09). Male gender was also a significant risk factor (OR: 2.27, CI: 1.13-4.56) in group 0-36., Conclusion: Higher grade dislocations and male gender are significant risk factors for failure of reduction in closed reduction in hip dislocation in DDH.

Introduction: Metallosis which is traditionally associated with Metal-on-Metal (MoM) hip arthroplasty can occur with other bearing surfaces too, posing diagnostic challenges. They can be asymptomatic or present with local and systemic symptoms. This article reports a case of metallosis in a total hip replacement (THR) with metal on polyethylene (PE) articulation who presented with dislocation. It also reviews the pathology and various presentations of metallosis following hip arthroplasty., Case Report: A 35-year-old female patient presented 4 years after a left THR with recurrent dislocation. It was an uncemented prosthesis with metal on PE articulation. Serology and radiological investigations were done to evaluate for infection, implant loosening, implant malposition, etc. The femoral stem appeared to be in varus malposition. She was posted for revision surgery with a pre-operative plan to change the femoral stem and head if necessary. Intraoperative signs of local metallosis were noticed. Debridement was done along with the change of the femoral stem and bearing surface to ceramic on PE. Metallosis was also later confirmed by the histopathological report. The patient has been symptom-free during the 2-year follow-up period., Conclusion: Metallosis can occur even in non-MoM articulations and a high degree of clinical suspicion is required to detect the same preoperatively. Classical signs of metallosis can often be absent in the early disease and subtle signs of instability must be looked out for even in the absence of obvious misalignment in radiographic assessment. Metallosis when combined with malposition or malalignment can be more detrimental. If detected early before osteolysis and periarticular soft tissue damage sets in, a complete revision of all the implant components and abductor damage can be avoided. In suspected cases, a lower threshold should be adopted for sending blood and joint aspirates for cobalt-chromium levels., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Introduction: Floating hip with hip dislocation is a very high-energy, devastating, and rare injury whose treatment is very challenging, and the outcome is usually poor., Case Report: A 35-year-old man presented posterior wall fracture acetabulum and dislocation of the hip with ipsilateral distal third shaft femur fracture with intra-articular extension fracture and un-displaced patella fracture. We achieved a reduction of hip dislocation by a knee-spanning external fixator followed by open reduction and internal fixation with anatomical locking plate for distal third femur fracture with intra-articular extension followed by open reduction and internal fixation for posterior wall of acetabulum with recon plate in Kocher-Langenbeck approach in stages. The patient was able to partial weight bear after 12 weeks of the injury and mobilized independently without any support after 5 months., Conclusion: Floating hip with hip dislocation is difficult to manage but reducing the hip dislocation with knee spanning external fixator and management in stages will reduce the complications and better outcome., Competing Interests: Conflict of Interest: Nil, (Copyright: © Indian Orthopaedic Research Group.)

Abstract Background Femoral neck fracture combined with anterior dislocation of the femoral head is very rare. To our knowledge, there is no classification system yet for this rare form of injury, and the injury mechanism of femoral neck fracture combined with obturator head dislocation has not been described in the literature. In this study, we systematically reviewed the literature and the cases treated in our hospital, and identified and classified all injury types according to the injury mechanism of femoral neck fracture combined with anterior dislocation of the femoral head. Further, based on the experience of treating a patient with femoral neck fracture and obturator dislocation of the femoral head, a theoretical hypothesis was proposed for the injury mechanism of this rare type of injury. Methods A comprehensive search was conducted on PubMed, WOS, CNKI database. These fractures were classified according to the dislocation site and injury mechanism (one injury or two injuries). Results 1891 articles were initially identified through PubMed and other databases, and after bibliographic research, study screening, and removing duplicates, 1455 articles were selected. After applying the exclusion criteria, a total of 18 full-text articles describing femoral neck fractures combined with anterior dislocation of the femoral head. Different dislocation sites have different injury mechanisms. Our classification system, to the best of the authors’ knowledge, allowed us to include all types of femoral neck fractures combined with anterior dislocation of the femoral head from the literature. According to the proposed classification system, the morphological features of femoral neck fracture combined with anterior dislocation of the femoral head can be accurately conveyed between doctors. Conclusions All injury patterns can likely be identified using the proposed classification system. This can help avoid confusion in the nomenclature of femoral neck fractures combined with anterior dislocation of the femoral head and help surgeons to more accurately detect lesions, thereby guiding surgical treatment.

Introduction The article is a literature review focusing on reconstruction surgery for dislocated hips in children with cerebral palsy (CP). Material and methods Publications in Scopus, PubMed, RSCI indexed journals over the past 20 years were reviewed for hip dislocation in children with CP. Results and discussion The article discusses the prevalence of the orthopaedic complication of cerebral palsy, pathogenesis, diagnosis, indications to surgery, choice of surgical technique, early rehabilitation and long-term outcomes. A report made for the first educational meeting of the European Pediatric Orthopaedic Society held in Russia at the Ilizarov Center in 2021 was used for the contribution. Conclusion Surgical treatment is indicated for hip dislocation in children with CP using holistic approach and principles of single-event multilevel surgery that suggest hip reconstruction, addressing contractures and deformities of the subjacent segments and creating conditions for postoperative postural management. Standardized indications, patient selection and optimal time for intervention are to be carefully considered for the procedure with the use of customized orthopaedic implants and techniques.

The prevalence of osteoporotic acetabular fractures and fracture-dislocations of the hip is increasing worldwide. These injuries are difficult to treat, and outcomes using traditional methods of osteosynthesis have been generally disappointing. Currently, there is debate about the management strategies with no widely held consensus on which technique is best. Studies from tertiary centers in North America and Europe have reported excellent results using the “combined hip procedure” which merges osteosynthesis and acute hip arthroplasty to treat these challenging fractures. As our population ages, these injuries are likely to occur more commonly in the developing world. We describe a case of an 80-year-old man who sustained a posterior fracture-dislocation of his hip and underwent successful treatment using the combined hip procedure in a low-resource setting.

Introduction: Dislocation following hip hemiarthroplasty is a serious complication. It remains unclear if acetabular morphology is associated with a higher risk of dislocation. The aim of our study was to investigate whether there are differences in hip morphology radiological parameters between patients who have suffered a dislocation episode, and those who have not suffered a dislocation. Material and methods: Between January 2015 and December 2018, a nested case-control study was performed. From 707 patients who underwent hip hemiarthroplasty because of femoral neck fracture, 50 patients (50 hips) suffered an episode of dislocation. They were randomly matched with 94 patients (100 hips) without dislocation (ratio 1:2). Clinical data regarding demographics, medical comorbidities and surgical and radiological parameters were studied. Results: Statistically significantly smaller lateral centre-edge angle (LCEA) and femoral offset (FO) and greater Tönnis angle were found in the dislocation group. No differences in acetabular angle were seen. Neurological impairment prevalence was statistically significantly higher in patients who suffered a dislocation (60% vs. 44%, p = 0.011). Conclusions: The current study suggests that a smaller LCEA and FO, a greater TA, and neurological impairment could be related to a higher risk of hip hemiarthroplasty dislocation after femoral neck fracture in the elderly. We consider that preoperative templating could be helpful in identifying abnormal parameters and carefully planning surgery could lead to changes in treatment strategy, such as choosing a dual-mobility total hip arthroplasty. [ABSTRACT FROM AUTHOR]

The success of developmental dysplasia of the hip treatment is closely linked to early intervention, that is, early and safe diagnosis and treatment. The radiographic study has traditionally been based on the measurement of a series of parameters, which is carried out using the goniometer, marking directly on the radiograph. However, this procedure has its disadvantage. The present study aims to expose the characteristics of a template to measure the hip with dysplastic development in infants. It explains how to proceed with the proposed tool; its possibilities and application methodology are argued, and its feasibility from a practical point of view is illustrated. The template allows evaluation of the infant's hip, regardless the femoral head nucleus ossification; as well as determines if the hip is normal; and if it is pathological, classifies it depending on the degree of severity of the condition. [ABSTRACT FROM AUTHOR]

Aim: The two most commonly used approaches for hip hemiarthroplasty operations are the lateral and posterior approaches (PAs). The PA is claimed to have a higher risk of dislocation. In this context, we aimed to investigate if there is a difference between posterior and lateral approaches (LAs) in terms of postoperative dislocation rates. Mortality rates and the risk of operative periprosthetic fracture were also analyzed. Methods: A retrospective investigation was conducted of patients who underwent hip hemiarthroplasty for a femur neck fracture at our hospital between 2010 and 2020. The operation notes, medical records in the hospital electronic records system, and the Turkish national health record system (E-nabız personal health system) were reviewed. Patients with additional severe diseases or trauma that may affect the risk of dislocation were excluded from the study. Patients were grouped into the PA group and the LA group. PAs were performed using the Moore technique, and LAs were performed using the modified Hardinge technique. Dislocation, periprosthetic fractures, and mortality rates were noted. Results: There were 321 females and 147 male patients in the study. The PA group included 262 patients, and the LA group, 206. There were 6 dislocations and 5 periprosthetic fractures in the PA group and 2 dislocations and 1 periprosthetic fracture in the LA group, with a minimum of 1-year follow-up. The difference was not statistically significant. The mortality rates in postoperative years 1 and 10 were 26.4% and 82.1%, respectively. The lateral versus PA had no statistically significant effect on these rates. Conclusion: Since there was no significant difference between these approaches in terms of dislocation, periprosthetic fracture, and mortality rates; it was concluded that the choice of approach should depend on surgeon preference and experience. [ABSTRACT FROM AUTHOR]

Hip precautions are movement restrictions that are often advised following primary total hip arthroplasty (PTHA) for osteoarthritis (OA), but there is limited evidence supporting their effectiveness in preventing dislocation. This study aimed to explore the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. Semi-structured interviews were conducted with therapists and surgeons at six centres using precautions and six centres not using precautions across secondary or tertiary NHS sites in England. Interviews were transcribed verbatim and thematically analysed. Interviews were conducted with fourteen surgeons and eighteen therapists. Of these clinicians, eight surgeons and ten therapists routinely advised precautions. Clinicians continued to use precautions to avoid dislocation by creating a boundary to movement, particularly important when dealing with patients who "push" these boundaries. Clinicians discontinued precautions because of a perceived negative impact on patients and the lack of supporting evidence. In the absence of a rise in dislocation rates for these centres, others have now changed practice. This study offers insight into the clinical reasoning behind the continuation and discontinuation of hip precautions following PTHA for OA. The use of precautions remains controversial and further work is required to determine whether or not they should be advised. Redesign of future rehabilitation pathways for primary total hip arthroplasty should take into account viewpoints from across the multidisciplinary team to aid decision making. Concern for patient behaviours, dislocation and litigation may be barriers to changing practice for rehabilitation after primary total hip arthroplasty. Clinicians may be discontinuing hip precautions because of known surgical advances, a perceived negative impact on patients and a lack of supporting evidence for historical practice. Individualised rehabilitation considerations are necessary for patients with risk factors that predispose them to dislocation after primary total hip arthroplasty, regardless of whether hip precautions are advised as standard at their given centre. [ABSTRACT FROM AUTHOR]

To determine if hip movement precautions reduce hip prosthesis dislocation rates post hip arthroplasty using a posterior surgical approach compared to minimal or no movement restrictions. This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. CINAHL, MEDLINE and Embase were searched from inception until September 2020 supplemented by citation tracking. Studies were included if patients had a hip arthroplasty using a posterior surgical approach with comparative data on hip movement precautions or minimal to no movement restrictions. Methodological quality was evaluated using the Downs and Black checklist. From a yield of 8 studies, meta-analysis of 7 studies and 9599 total hip arthroplasties, there was low quality evidence of no increased risk of dislocation (RR = 0.98, 95%CI 0.58 to 1.67) for patients prescribed minimal or no hip movement restrictions compared with patients prescribed hip movement precautions. There were 121/5440 dislocations (2.2%) in the movement precaution group and 90/4159 dislocations in the minimally restricted group (2.2%). Dislocation rates after total hip arthroplasty are low irrespective of movement precaution allocation. Resources allocated to implementing hip movement precautions may be better directed towards other clinical areas. There was no difference in hip prosthesis dislocation rate between patients who received hip movement precautions compared to patients who received minimal or no restrictions after total hip arthroplasty using a posterior surgical approach. Health professionals involved in prescribing and monitoring adherence to hip movement precautions after total hip arthroplasty may be better allocating their resources to other areas of clinical care. Falls were associated with the greatest number of prosthesis dislocations, accounting for 24% of dislocations; resources may be better allocated towards evidence-based strategies to reduce falls. [ABSTRACT FROM AUTHOR]

Developmental dysplasia of the hip (DDH) is the instability or dislocation of the hip joint at birth that may occur in utero, during infancy, and childhood. This condition was identified as an important challenge. This study aimed to determine the clinical and ultrasound results of Pavlik harness treatment for DDH in patients referred to the pediatric clinic of Imam Khomeini Hospital in Ahvaz. This is a descriptive cross-sectional study in which 100 newborns aged 15 to 30 days were included by the census method after obtaining parental consent. Follow-up of the infants was performed at 3 and 6 months after treatment. All analyzes were performed using SPSS version 22 at a significance level of 0.05. The results showed that the mean age of the infants was 23.46±2.12 days, of which 33 infants were boys and 67 girls. The involvement on the right and left sides was 39% and 50%, respectively, and 11% of the infants had bilateral involvement. The mean value of acetabular index before placement was 25.48±6.509 and 26.38±3.866 on the right and left sides, which after 3 months of placement, was reduced to 21.62±2.578 and 21.57±2.839, respectively. Pavlik harness treatment was associated with acceptable radiological results in infants. This technique seems to be a suitable and applicable attempt to treat this problem and prevent serious and irreversible complications of late diagnosis. [ABSTRACT FROM AUTHOR]

Introduction: Dislocations of the hip joint are a common and clinically relevant complication following total hip arthroplasty (THA). Hip-abduction braces are currently used following operative or non-operative treatment of THA dislocations to prevent re-dislocations. However, the clinical and biomechanical effectiveness of such braces is still controversial. Material and methods: A total of 30 volunteers were measured during standing and during sitting up and down from a chair task wearing a hip brace set at 70°, 90° or no hip flexion limitation. Range of motion of the hip joint was measured in all directions by an inertial sensor system. Further it has been evaluated if the range of motion would be reduced by the additional use of an arthrodesis cushion. Results: The use of a hip brace set up with flexion limitation did reduce hip ROM in all directions significantly compared to unhinged brace (p < 0.001–0.035). Performing the "sit down and stand-up task" the brace set up at 70° flexion limitation did reduce maximum hip flexion significantly (p = 0.008). However, in most cases the measured hip flexion angles were greater than the settings of the hip brace should have allowed. The additional use of a cushion can further limit hip motion while sitting up and down from a chair. Conclusion: This study has demonstrated that hip-abduction braces reduce hip range of motion. However, we also found that to achieve a flexion limitation of the hip to 90°, the hip brace should be set at a 70° hip flexion limitation. [ABSTRACT FROM AUTHOR]

Objective: To investigate if using a hip bandage is more effective than standard care in the prevention of total hip arthroplasty re-dislocation in patients with a previous total hip arthroplasty dislocation. Design: randomized controlled trial Setting: Holstebro Regional Hospital and Viborg Regional Hospital Subjects: A total of 99 patients, 51 women, mean 70.7 (SD 9.9) years were enrolled in an un-blinded, clinical randomized controlled trial. Interventions: Participants with at least one previous total hip arthroplasty dislocation were randomized to either wearing a bandage reducing flexion, adduction, and internal rotation of the hip (intervention group) or to standard care (control group). The participants were followed for 12 weeks. Main follow-up measures were as follows: number of re-dislocations (primary outcome), hip disability measured with the Oxford Hip Score (0–48, 48 best), quality of life measured with the 36-Item Short Form Survey (0–100, 100 best), satisfaction with treatment and serious adverse events. Statistical analyses followed the intention-to-treat principle. Results: No significant group differences were observed for the primary outcome re-dislocations (9 versus 15, P = 0.143) or for disability (11.3 versus 14.4, P = 0.161), quality of life (57.7 versus 48.3, P = 0.050) or satisfaction with treatment (P = 0.562). There were 3 serious adverse events leading to total hip arthroplasty revision in the intervention group and 4 in the control group. Conclusion: We found that a hip bandage is not superior to standard care in the prevention of total hip arthroplasty re-dislocation in those with a previous total hip arthroplasty dislocation. [ABSTRACT FROM AUTHOR]

Introduction: Posterior hip dislocation is the commonest type of hip dislocation. It is associated with femoral head fracture in 7% of cases. Urgent and congruent hip reduction is mandatory to improve clinical outcomes and avoid irreversible complications. The purpose of this study is to assess the safety and functional and radiological outcomes of surgical hip dislocation by Ganz technique for treatment of femoral head fracture.Patients and Methods: In this retrospective study, 18 cases of femoral head fracture were included. Six cases had Pipkin type I and 12 had Pipkin type II fracture. They were treated through surgical hip dislocation. All cases were followed up for at least 24 months. Matta's criteria were used for radiological evaluation (plain radiographs). Functional evaluation was done using Harris Hip Score and modified Merle d'Aubigne and Postel score at final follow-up.Results: No patients were lost during the follow-up period. No signs of infection or wound dehiscence were noted in this study. There was one case of osteonecrosis. All cases had labral injury, which was debrided. None of our cases needed suture anchor repair of the labrum. Radiographical evaluation according to Matta's criteria yielded anatomic fracture reduction in 17 patients but imperfect in 1 patient. According to Harris Hip Score, four Pipkin type I cases were rated as excellent and two as good. Among cases of Pipkin type II fracture, six were rated as excellent, four as good, one as fair, and one as poor. According to modified Merle d'Aubigne and Postel score, 11 cases had excellent results, 5 cases were rated as good, one as fair, while one case had poor results.Conclusion: Open reduction and internal fixation of femoral head fracture using surgical hip dislocation through Ganz approach is a viable treatment option and provides satisfactory results with low complication rate. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the accuracy of measurement of the pubofemoral distance (PFD) for the diagnosis of developmental dysplasia of the hip (DDH), using the Graf method as the reference standard. Methods: This was a prospective diagnostic accuracy study evaluating 1980 hips in at‐risk neonates. The PFD measurement and the Graf method were performed at the same opportunity, with the hips in the same position (slightly flexed, adducted, and medially rotated). Results: In our sample, the prevalence of DDH, defined as Graf type IIb or higher, was 15.6%. The mean PFD for dysplastic hips was 3.5 mm (median, 3.3 mm), whereas it was 3.0 mm (median, 2.9 mm) for nondysplastic hips. In both groups, there was a significant overlap between the PFD measurements and the Graf classifications. The PFD cutoff with the largest area under the receiver operating characteristic curve was 3.0 mm, which was found to have a sensitivity and specificity of 63.6 and 62.2%, respectively, with positive and negative predictive values of 31.2 and 71.4%, respectively, for the diagnosis of DDH. Conclusion: Measurement of the PFD shows good overall accuracy for the diagnosis of DDH. However, given its low‐positive predictive value, it should not be considered to be a replacement for the Graf method. [ABSTRACT FROM AUTHOR]

The incidence of prosthetic hip dislocation continues to increase because of the overall increase in volume of total hip replacement surgery. Closed reduction is often the preferred treatment, particularly in the first few months after surgery. No matter the closed reduction technique, linear traction is a requirement, thus posing a physically demanding stress opening both surgeon and patient to potential injury. We describe a fracture table closed reduction technique along with outcomes and safety data for a sample of patients. In all 10 reduction procedures, reduction was achieved quickly and without fracture or anesthetic complication. The use of a fracture table for reduction of prosthetic hip dislocation is a viable option, particularly when the surgeon may not have the physical requirements and/or qualified assistance necessary for reduction in the emergency department.

BACKGROUND: Femoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center. MATERIALS AND METHODS: A retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis. RESULTS: We identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision. CONCLUSIONS: Fractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon. LEVEL OF EVIDENCE: IV-prognostic.

BackgroundFemoral head fractures are uncommon injuries. Small series constitute the majority of the available literature. Surgical approach and fracture management is variable. The purpose of this study was to evaluate the incidence, method of treatment, and outcomes of consecutive femoral head fractures at a regional academic Level I trauma center.Materials and methodsA retrospective review of a prospective database was performed over a 13-year period. All AO/OTA 31C femoral head fractures were identified. A surgical approach and fixation method was recorded. Clinical and radiographic evaluation was performed for patients with 6 months or greater follow-up. Radiographs were evaluated for fixation failure, heterotopic ossification (HO), avascular necrosis (AVN) and post-traumatic arthritis.ResultsWe identified 164 fractures in 163 patients; 147 fractures were available for review. Treatment was operative reduction and internal fixation (ORIF) in 78 (53.1%), fragment excision in 37 (25.1%) and non-operative in 28 (19%). An anterior approach and mini-fragment screws were used in the majority of patients treated with fixation. Sixty-nine fractures had follow-up greater than 6 months. Sixty-two fractures (89.9%) proceeded to uneventful union. All Pipkin III fractures failed operative fixation. Six patients developed AVN, seven patients had a known conversion to hip arthroplasty; HO developed in 28 (40.6%) patients and rarely required excision.ConclusionsFractures of the femoral head are rare. An anterior approach can be used for fragment excision or fixation using mini-fragment screws. Pipkin III fractures represent catastrophic injuries. Non-bridging, asymptomatic HO is common. AVN and posttraumatic degenerative disease of the hip occur but are uncommon.Level of evidenceIV-prognostic.

BackgroundThe most common bearing surface used among primary THAs worldwide is a metal or ceramic femoral head that articulates against a highly crosslinked ultrahigh-molecular-weight polyethylene (HXLPE) acetabular liner. Despite their widespread use, relatively little is known about the comparative effectiveness of ceramic versus metal femoral heads with respect to risk of revision and dislocation as well as the role of head size in this relationship.Questions/purposesThe purpose of this study was to evaluate the risk of (1) all-cause revision in metal versus ceramic femoral heads when used with an HXLPE liner, including an evaluation of the effect of head size; and (2) dislocation in metal versus ceramic femoral heads when used with an HXLPE liner as well as an assessment of the effect of head size.MethodsData were collected as part of the Kaiser Permanente Total Joint Replacement Registry between 2001 and 2013. Patients in this study were on average overweight (body mass index = 29 kg/m2), 67 years old, mostly female (57%), and had osteoarthritis (93%) as the primary indication for surgery. The material of the femoral head (metal, ceramic) was crossed with head size (< 32, 32, 36, > 36 mm), yielding eight device groupings. Only uncemented devices were evaluated. The primary outcome was all-cause revision (n = 28,772) and the secondary outcome was dislocation within 1 year (n = 19,623). Propensity scores were used to adjust for potential confounding at the implant/patient level using between-within semiparametric survival models that control for surgeon and hospital confounding and adjust estimates for the within-cluster correlation among observations on the response.ResultsFor all-cause revision, there was no difference between ceramic versus metal (reference) heads in combination with an HXLPE liner (hazard ratio [HR] = 0.82 [0.65-1.04], p = 0.099). Smaller metal head sizes of < 32 mm were associated with increased risk of revision relative to 36 mm (HR = 1.66 [1.20-2.31], p = 0.002, adjusted p = 0.025). For dislocation, ceramic heads increased risk relative to metal at < 32 mm only (HR = 4.39 [1.72-11.19], p = 0.002, adjusted p = 0.020). Head sizes < 32 mm were associated with increased risk of dislocation relative to 36 mm for metal (HR = 2.99 [1.40-6.39], p = 0.005, adjusted p = 0.047) and ceramic heads (HR = 15.69 [6.07-40.55], p < 0.001, adjusted p < 0.001).ConclusionsThe results did not provide evidence for use of one femoral head material over another when used with HXLPE liners for the outcome of revision, but for dislocation, metal performed better than ceramic with < 32-mm heads. Overall, the findings suggest increased risk of revision/dislocation with head sizes < 32 mm.Level of evidenceLevel III, therapeutic study.

The popularity of yoga and the prevalence of total hip arthroplasty (THA) have simultaneously increased in the United States. Accordingly, one can assume that the number of THA patients practicing yoga has increased. Certain yoga poses reach the extremes of hip range of motion, potentially leaving patients vulnerable to dislocation. To date, 2 cases of late posterior prosthetic hip dislocations during yoga have been reported; however, there have been no reports of anterior prosthetic hip dislocations. We present one case of late anterior prosthetic hip dislocation during yoga in a patient who underwent THA via the direct anterior approach. Prosthetic hip dislocation during yoga may be a growing concern. We provide additional evidence in support of recommendations for THA patients to safely practice yoga.

Abstract Background Although pelvic incidence (PI) is a key morphologic parameter in assessing spinopelvic sagittal alignment, accurate measurements of PI become difficult in patients with severe hip dislocation or femoral head deformities. This study aimed to investigate the reliability of our novel morphologic parameters and the correlations with established sagittal spinopelvic parameters. Methods One hundred healthy volunteers (25 male and 75 female), with an average age of 38.9 years, were analysed. Whole-body alignment in the standing position was measured using a slot-scanning X-ray imager. We measured the established spinopelvic sagittal parameters and a novel parameter: the sacral incidence to pubis (SIP). The correlation coefficient of each parameter, regression equation of PI using SIP, and regression equation of lumbar lordosis (LL) using PI or SIP were obtained. The intraclass correlation coefficient (ICC) was calculated as an evaluation of the measurement reliability. Results Reliability analysis showed high intra- and inter-rater agreements in all the spinopelvic parameters, with ICCs > 0.9. The SIP and pelvic inclination angle (PIA) demonstrated strong correlation with PI (R = 0.96) and pelvic tilt (PT) (R = 0.92). PI could be predicted according to the regression equation: PI = − 9.92 + 0.905 * SIP (R = 0.9596, p

The incidence of hip dislocation (HD) in arthrogryposis multiplex congenital ranges from 15 to 30 %. Besides a stable hip, the ambulation potential of an AMC child is also dependent on severity of associated knee and foot deformations. The primary objective of this review is to determine the proportion of ambulators in AMC children treated by open reduction for HD. We searched major electronic bibliographic databases for reports on the treatment of HD among AMC children. Based on the surgical approach for open reduction of HD in AMC children, we divided the included studies into groups 1 (Anterior approach open reduction) and 2 (Medial approach open reduction). We pooled 59 children/94 hips in this review from 7 studies. We identified 45 children/71 hips and 14 children/23 hips with a mean age of 20 (4–64) and 4.5 (0.5–11) months in groups 1 and 2, respectively. There were 97 % (44) and 92 %(Obeidat et al., 2011) 13 ambulators in groups 1 and 2, respectively. 47 % and 36 % of hips in groups 1 and 2 required additional procedures besides open reduction for redislocation and maintenance of hip reduction. 31 %22 and 13 %(Fisher et al., 1970 Feb) 3 of the hips sustained avascular necrosis in group 1 and 2. Children with AMC associated HD can be expected to ambulate with and without assistance in 90 % of the cases however, the foot and knee problems also need concomitant management. In children less than 6 months of age the medial approach based open reduction may be more efficacious and less complicating than anterior approach based open reduction however, at a later age anterior approach based open reduction is more effective due to need for pelvic and femur sided additional procedures. [ABSTRACT FROM AUTHOR]

Background: Children undergoing DDH correction surgery may experience gait abnormalities following soft tissue releases and bony procedures. The purpose of this study was to compare the residual gait changes, radiological outcomes, and functional outcomes in children who underwent DDH surgery with those in healthy controls. Methods: Inertial motion sensors were used to record the gait of 14 children with DDH and 14 healthy children. Pelvic X-ray was performed to determine the Severin classification and the presence of femoral head osteonecrosis (Bucholz–Odgen classification). For functional evaluation, the Children’s Hospital Oakland Hip Evaluation Scale (CHOHES) was used. Results: There was no difference in spatial parameters between the two groups. In terms of temporal parameters, the DDH-affected limbs had a shorter stance phase (p < 0.001) and a longer swing phase (p < 0.001) than the control group. The kinematic study showed that the affected limb group had smaller hip adduction angle (p = 0.002) and increased internal rotation (p = 0.006) with reduced upward pelvic tilt (p = 0.020). Osteonecrosis was graded II, III, and IV in five, three, and one patients, respectively. Five patients had no AVN changes. The Severin classification was grade I, II, and III for six, three, and five patients, respectively. Most patients had good functional outcomes on the CHOHES, with a mean total score of 96.64 ± 5.719. Multivariate regression analysis revealed that weight, height, and femoral osteotomy were independent predictors for gait, radiological and functional outcome. Conclusion: Despite good functional scores overall, some children had poor radiological outcomes and gait abnormalities. Our results identified the risk factors for poor outcomes, and we recommend specified rehabilitative strategies for long-term management.

Case: A 45-year-old man appeared to have a central (protrusio) hip dislocation but actually had a transverse posterior wall acetabulum fracture with irreducible posterior dislocation due to impalement of the femoral head on the ischial spine. He underwent urgent open reduction on presentation and subsequent internal fixation in a staged manner. He developed avascular necrosis at 18 months postoperatively. Conclusion: The nondisplaced ilioischial and iliopectineal acetabular radiographic lines were alerts that the dislocation was actually posterior. This led to further imaging before any closed reduction attempts because standard reduction maneuvers would have placed the patient at high risk for iatrogenic femoral head or neck fracture. [ABSTRACT FROM AUTHOR]

Objective: To determine the functional outcome of posterior lip acetabular fracture and hip dislocation fixed with reconstruction plate. Study Design: Descriptive Case Series study. Setting: Department of Orthopaedic, Dr Ruth K. M. Pfau Civil Hospital Karachi. Period: August 2014 to December 2020. Material & Methods: 36 patients were included in the study. Age between18 years to 60 years. All patients fixed with reconstruction plate. Harris hip score assessed at follow up till 12 months. Harris hip score above 90 was considered as excellent, between 70--89 as good and below 70 as poor. Results: The mean age of the patients was 43.67 ±11.56 years. Majority of the patients were males (n=29, 80.6%). Good functional outcome was found in (n=15, 41.7%) of the patients, excellent in 8 (22.2%) and poor in 13 (36.1%) patients. Satisfactory outcome was found in 23 (63.9%) patients. A significant association of satisfactory outcome was found with age (p-value <0.001). Avascular necrosis 7, infection 5 and arthritis in 6 patients noted. One patient had associated sciatic nerve palsy, three had head of femur fracture and 1 with ipsilateral midshaft femur fracture. Conclusion: For posterior hip dislocation with lip fracture we suggest emergency reduction and timely fixation of posterior lip fracture can improve the clinical outcome of patient and even complications happen in future it preserve the bone stock for the future arthroplasty procedure. [ABSTRACT FROM AUTHOR]

Purpose: The aim was to study the prevalence of hip displacements, dislocations, and the hip surgeries performed in a Finnish cohort of children with cerebral palsy not followed up in a hip surveillance program and to compare these with previous studies performed in Northern European countries before and after the implementation of hip surveillance programs. Methods: A cross-sectional study. A cohort including 480 children with cerebral palsy, born during the period 2000– 2018, not enrolled in a hip surveillance program. Migration percentages were recorded from hip radiographs, age at first hip surgery and type of surgery was extracted from medical records. In a separate analysis, the inclusion criteria were adapted to fit two studies analyzing hip dislocation and hip surgery in Sweden, Norway, and Scotland before and after the implementation of a hip surveillance program. Chi-square tests were used to assess differences in proportions between the groups. Results: In total, 286 children (60%) have had at least one hip radiograph. Of these, 10 (3.5%) developed hip dislocation, which is more than in children of countries with hip surveillance programs (Sweden 0.7%, Scotland 1.3%, p<0.001). Initial surgery to prevent hip dislocation was performed at an older age (p<0.001). Conclusion: Children with cerebral palsy in Finland not participating in a surveillance hip program were more likely to undergo hip surgery at an older age and to develop hip displacements and dislocations. The results support the effectiveness of surveillance programs to prevent hip dislocation in children with cerebral palsy. Level of evidence: III [ABSTRACT FROM AUTHOR]