1,721,026 research outputs found
Relative Femoral Neck Lengthening in Legg-Calvé-Perthes Total Hip Arthroplasty
No full textBackground: Total hip replacement (THR) in patients with a history of Legg-Calv e-Perthes disease can be
a technically challenging procedure due to the distorted hip morphology. We propose a technique in
which THR is preceded by a modified relative femoral neck lengthening (RFNL) procedure. Hereby, we
aim to restore the biomechanical parameters.
Methods: Twenty-eight patients underwent RFNL in preparation of a second-stage THR between
December 2011 and September 2019. The mean age was 38.1 ± 11.4 years. Radiographs were analyzed for
centrotrochanteric distance, lateral displacement of the greater trochanter, and leg length discrepancy to
assess the biomechanical restoration. Complication rate, reoperation rate, and patient-reported outcome
measures were measured.
Results: Mean centrotrochanteric distance increased from 18.7 ± 6.7 mm preoperatively to 1.9 ± 9.0
mm (P < .001) after RFNL and to 11.4 ± 10.4 mm after THR (P < .001). Mean lateral displacement of the
greater trochanter increased from 34.2 ± 8.1 mm preoperatively to 42.4 ± 5.2 mm (P < .001) after RFNL
and to 49.9 ± 8.3 mm after THR (P < .001). Leg length discrepancy decreased from 17.5 ± 10.5 mm to 2.7 ±
2.2 mm after THR (P < .001). Mean Harris Hip Score improved from 56.9 ± 17.6 preoperatively to 89.4 ±
10.7 at the latest follow-up (P < .001). Eight patients (8 hips) postponed THR because of sufficient clinical
improvement, at a mean follow-up of 4.2 ± 2.1 years. Two hips needed a revision RFNL due to non-union
(7.1%), and 1 hip replacement was revised due to a deep infection (5.0%).
Conclusions: RFNL prior to THR in patients with end-stage osteoarthritis following Legg-Calv e-Perthes
disease allows for utilizing regular implants with straight access to the femoral canal, with restored
biomechanics and restoration of leg length. The prominent overhanging greater trochanter is reduced to
prevent postoperative extra-articular impingement.RFNL prior to THR in patients with end-stage osteoarthritis following LCPD allows for utilizing regular implants with straight access to the femoral canal, with restored biomechanics and restoration of leg length
Cortical contact is not necessary to prevent stem subsidence in cementless trapeziometacarpal arthroplasty: A follow-up study
No full textCortical contact is not necessary to prevent stem subsidence in cementless trapeziometacarpal arthro-plasty: A follow-up study Le contact cortical n'est pas ne´cessaire pour pre´venir la migration de la tige dans l'arthroplastie trape´zo-me´tacarpienne sans ciment: e´tude de suivi Dear Editor, We previously reported that impacted cancellous bone can provide adequate stability for uncemented stems in the thumb metacarpal [1]. We based our conclusion on the fact that we did not observe radiographic subsidence at one year postoperatively in a series of 87 Maı¨aMaı¨a prostheses. In 77% of the cases, the stem was implanted without cortical bone contact on posteroanterior (PA) and lateral radiographic views. We reassessed the same patient group at a mean 6.1 years' follow-up (range, 2-10 years). Fifty-seven of the patients (75%) could be included, for 66 implants (76%). Three patients had died and two implants were removed because of trapezium fracture and infection. Like in the previous study, stem position was expressed as the ratio between the length of the metacarpal and the distance between the proximal end of the stem and the distal articular surface of the thumb metacarpal. Subsidence was determined by comparing stem position immediately after surgery and at last follow-up. Linear mixed models were used to obtain the mean and 95% confidence intervals for (1) stem position immediately after surgery, (2) stem position at final follow-up, and (3) change in stem position over time. On PA radiographs, the mean ratio immediately postoperatively was 1.414 (95% CI: 1.390; 1.438) and at follow-up 1.420 (95% CI: 1.390; 1.450). On average, this value decreased by 0.007 (95% CI: À0.009; 0.024) at follow-up, which was not statistically significant (p = 0.3871). On lateral radiographs, the ratio immediately postoperatively was 1.397 (95% CI: 1.374; 1.420) and at follow-up 1.406 (95% CI: 1.383; 1.428). The mean difference was 0.008 (95% CI: À0.0003; 0.016), and not significant (p = 0.060). The present study confirms that impacted cancellous bone can provide adequate primary stability to allow secondary bone ongrowth. However, other radiographic findings were observed. Minor heterotopic ossifications were present in most cases. One Hand Surgery and Rehabilitation 41 (2022) 707-708The authors have no potential conflicts of interest with respect to the research, authorship, and/or publication of this article
Extra-Articular Impingement at the Anterior Inferior Iliac Spine: A Cause of Refractory Periarticular Pain After Total Hip Arthroplasty
No full textBackground: Periarticular pain after total hip arthroplasty (THA) can significantly impair the post-operative functionality. Extra-articular impingement between the greater trochanter and the anterior inferior iliac spine is presented as a cause of refractive pain after THA. Methods: Twenty patients were treated for refractive periarticular pain and limited internal rotation between January 2014 and April 2016. All patients underwent a positive chair rise test, pelvic inclination test, and Marcainisation test. Patients were treated with bone resection of the anterior part of the greater trochanter with or without component revision. Results: At a mean follow-up of 20 months, all functional outcomes had improved significantly. All patients were willing to undergo the surgery again. Sixteen (80%) indicated the result as very good, 3 (15%) as good, and one (5%) as poor. Two patients developed a postoperative heterotopic ossification that required resection. Conclusions: Extra-articular impingement should be considered as a possible cause of refractive groin pain after THA. Bony resection through the Hueter interval provides immediate pain relief with improved functional outcomes 1 year after surgery
The peri-articular muscle envelope of the hip (PAME) shows atrophy in patients with refractory groin pain after iliopsoas tenotomy
No full textBackground:
Iliopsoas tenotomy is commonly used to address refractory groin pain resulting from iliopsoas tendinopathy. However, consensus and high-level research on its effectiveness are lacking, with concerns about poor outcomes and complications. Little is known of the effects of iliopsoas tenotomy on the peri-articular muscle envelope of the hip. As the iliopsoas loses its function as the most important hip flexor, the rectus femoris takes over its function, which makes the rectus prone to tendinopathy.
Methods:
A retrospective review of patients (n = 17) undergoing iliopsoas tenotomy between January 2016 and January 2021 was conducted. Pelvic MRI scans were evaluated for muscle quality and volume using a Quartile classification system and cross-sectional area (CSA) measurements. Reliability tests determined the most consistent reference points. Statistical analyses assessed changes between ipsilateral and contralateral sides.
Results:
Following iliopsoas tenotomy, significant reduced cross sectional area was seen in the psoas, iliacus, gluteus minimus, gluteus maximus, rectus femoris, piriformis, obturator internus and obturator externus. Significant increased fatty degeneration was seen in the psoas, iliacus, gluteus minimus, tensor fascia latae, piriformis, obturator internus and obturator externus. The gluteus medius was the only muscle where no difference was seen in the cross sectional area or the fatty degeneration. 15 patients (88%) presented with rectus tendinopathy and 8 of these patients had a surgical debridement of the rectus femoris.
Conclusions:
Our findings reveal that patients with persistent groin pain following iliopsoas tenotomy exhibit changes in the peri-articular muscle envelope, displaying atrophy or fatty degeneration in all muscles except the gluteus medius. Awareness of potential risks is crucial when contemplating iliopsoas tenotomy. Persistent groin pain after iliopsoas tenotomy may be linked to secondary rectus femoris tendinopathy. Caution is recommended in the consideration of iliopsoas tenotomy for patients with pre-existing iliopsoas tendinopathy.The author(s) received no financial support for the research, authorship and/or publication of this article
Gluteus Maximus Transfer as an Augmentation Technique for Patients With Severe Abductor Deficiency of the Hip
No full textImpaired abductor function of the hip following severe abductor deficiencies can be devastating for functionality and quality of life. Recently, gluteus maximus transfer has been proposed as a solution to these difficult problems. However, outcome results are sparse. The aim of this study was to evaluate the effects of gluteus maximus transfer on improvement of pain, disability, and quality of life in patients with severe hip abductor deficiencies. Gluteus maximus transfer was performed in 16 patients with severe disruption of the abductor muscles of the hip. Data were collected preoperatively and at 6 weeks, 3 and 6 months, and 1 to 2 years after surgery. The measurements pertained to complications, healing of the flap based on magnetic resonance imaging (MRI) findings (in 10 patients), evaluation of Trendelenburg gait and sign, and patient-reported outcome measures of pain, disability, and quality of life. Preoperatively, all patients had a positive Trendelenburg sign and reported severe pain at the level of the greater trochanter. At a mean follow-up of 20 months,the Trendelenburg sign was negative in 7 patients and the Trendelenburg gait had disappeared in 7 patients. There was an improvement in patient-reported outcome measures but not to a significant level except for the pain subscores. Two patients had a postoperative seroma that resulted in a visible bump on the lateral side. Seven of 10 repairs with MRI follow-up showed perfect ingrowth on MRI without signs of rerupture. Gluteus maximus transfer for abductor deficiency of the hip may be effective for pain relief and functional improvements.Most patients showed an improved quality of life but were not completely pain free.Corten, K (corresponding author), Hosp Zuid Oost Limburg Genk, Dept Orthoped Surg, Schiepse Bos 6, B-3600 Genk, Belgium.
[email protected]
Inter-individual differences in early post-operative pain, cognitions, and emotions after total hip arthroplasty: A longitudinal cohort study
No full textObjective To identify (1) pre- to early post-operative changes in pain and related cognitions and emotions, (2) early post-operative pain trajectories and their covariates, and (3) predictors of early post-operative cognitions and emotions. Design Longitudinal cohort study. Setting Secondary care setting at Hospital East-Limburg and the European Hip Center (Belgium). Participants One hundred thirty-three individuals with hip osteoarthritis undergoing total hip arthroplasty. Intervention Data were collected before total hip arthroplasty and during the first post-operative week. Main measures Sociodemographic information, traumatic experiences, anxiety, depression, perceived injustice, fear-avoidance, self-efficacy, and pain-related variables were assessed. Statistical analyses included Friedman tests to evaluate pre- to post-operative changes in pain and related cognitions and emotions, Latent Class Growth Analysis and multinomial logistic regression to identify pain trajectories and their covariates, and Least Absolute Shrinkage and Selection Operator regression to identify predictors of early post-operative cognitions and emotions. Results Four early post-operative pain trajectories were identified. Two trajectories (36%, n = 48) demonstrated no reduction in pain intensity one week after surgery. Higher levels of self-efficacy (odds ratio = 0.83) and pre- to post-operative reductions in perceived injustice (odds ratio = 0.86) were associated with lower odds of being classified in the unremitting pain trajectory. Between 38% and 64% in the variance of early post-operative cognitions and emotions could be predicted. Pre-operative perceived injustice showed a positive association with fear-avoidance (ss = 1.96) and anxiety symptoms (ss = 0.80). Conclusions Inter-individual differences exist in early post-operative pain after total hip arthroplasty but are poorly associated with cognitions or emotions. Pre-operative perceived injustice may influence early post-operative cognitions and emotions. Registration: ClinicalTrials.gov, NCT05265858 (https://classic.clinicaltrials.gov/ct2/show/NCT05265858)The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Universiteit Hasselt (Grant No. BOF20OWB15)
SCREENING FOR ANTIBODY REACTIVITY IN EARLY AXIAL SPONDYLOARTHRITIS IDENTIFIES NOVEL ANTIGENIC TARGETS
No full textAre the history of traumatic experiences and pain-related cognitions and emotions associated with pain and disability before and after total hip arthroplasty? a preliminary analysis
No full textBackground and aims
The aim of this study was to investigate whether traumatic experiences and preoperative pain-related cognitions and emotions are related to pain and disability before and after total hip arthroplasty (THA).
Methods
Ten patients with hip osteoarthritis (mean age: 59.60±13.70) were included in the preliminary analysis of a larger prospective study(N=200). Traumatic experiences were assessed preoperatively with the Traumatic Experiences Checklist and the Childhood Trauma Questionnaire. Pain-related cognitions and emotions were assessed preoperatively with the Fear-Avoidance Component Scale and the Injustice Experience Questionnaire. The Hip Disability and Osteoarthritis Outcome Score was used to assess pain and disability before and three months after THA. Spearman correlation coefficients were calculated.
Results
Preoperative fear-avoidance showed a high positive correlation with pre-and postoperative pain and disability (.729 and .867, respectively). The presence of childhood trauma or perceived injustice was not significantly correlated with preoperative pain and disability, but showed significant positive correlations with postoperative pain and disability (.722 and .646, respectively). No significant correlation was found between the Traumatic Experiences Checklist and pre-or postoperative pain and disability.
Conclusion
Preoperative fear-avoidance showed a high positive correlation with pre-and postoperative pain and disability in persons with hip osteoarthritis/after THA. While no association was found preoperatively, childhood trauma and perceived injustice were positively correlated with postoperative pain and disability. Given the small sample size, these preliminary results should be interpreted cautiously. Future research will investigate the above associations, and the prognostic value of traumatic experiences and pain-related cognitions and emotions for pain and disability after THA in a larger sample size
SCREENING FOR ANTIBODY REACTIVITY IN EARLY AXIAL SPONDYLOARTHRITIS IDENTIFIES NOVEL ANTIGENIC TARGETS
No full textCan patients who have low-grade hip osteoarthritis expect the same outcome after total hip arthroplasty compared to those who have end-stage osteoarthritis? - A Matched Case-Control Study
No full textBackground
Total hip arthroplasty (THA) is an effective procedure for patients with end-stage hip osteoarthritis (OA). In addition, when hip preservation surgery is no longer indicated due to the presence of early or mild arthritic changes, THA can also be considered. Whether these patients can expect the same outcome after THA as patients who have end-stage OA remains unclear. The goal of this study was to compare the clinical outcomes after THA of patients who have low-grade OA versus a matched cohort with end-stage OA.
Methods
This is a retrospective, single-center, multi-surgeon case-control study in a high-volume referral center. Based on a cohort of 2,189 primary anterior approach THAs (1,815 patients), 50 low-grade OA cases were matched 1:1 by age, sex, and Body Mass Index (BMI) to 50 controls who have end-stage OA. Patient-reported outcomes (PROMS) were Hip Disability and Osteoarthritis Outcome Scores (HOOS) and Short Form-36 (SF-36).
Results
No significant differences in preoperative PROMs between low-grade and end-stage OA patients were found, except for SF-36 pain (33.0 versus 41.0; P = 0.045). In both groups a significant improvement of all PROMs was found postoperatively. However, all HOOS scores were significantly lower in the low-grade OA group compared to the end-stage OA group. In the group with low-grade OA, a significantly lower percentage of patients achieved the minimum clinically important difference (MCID) and substantial clinical benefit (SCB) after THA compared to the group with end-stage OA.
Conclusion
Patients who have low-grade OA can expect substantial clinical improvement after THA. However, the improvement is lower compared to patients who have end-stage OA. A thorough understanding of the factors that may lead to inferior clinical outcomes is imperative to improving the indications for THA in individuals who have low-grade OA.This research did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors
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