Hip Arthroplasty

Hip replacement is one of the most performed surgical procedures in orthopedic hip surgery. Through this surgery, the patient returns to most of his normal life and a life without pain. The primary indication for a hip arthroplasty remains osteoarthritis (OA). OA is a degenerative disease that affects synovial joints. A successful surgery is always preceded by good planning. The planning in turn takes into account the analysis of the patient and his physical examination and the radiological image. But also, the surgical planning must take into account another important factor, the choice of the surgical approach. In this chapter, the authors script a revision on the history of hip arthroplasty, total hip arthroplasty approaches, implant types, complications associated with hip arthroplasty, outcomes, and perspectives to the future. We wish you a good reading

Strategy to avoid vascular injuries in revision total hip arthroplasty with intrapelvic implants

Aims: Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods: Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results: In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the orthopaedic procedure. Four patients needed a second reinforcing stent to protect and to maintain the vessel anatomy deformed by the intrapelvic implants. Conclusion: The evaluation algorithm was useful to avoid blood vessels injury during revision total hip arthroplasty in high-risk patients

Prevalência de achados radiográficos de impacto fêmoro-acetabular em indivíduos assintomáticos entre 20 e 40 anos

Introdução: As alterações anatômicas do fêmur proximal ou do acetábulo, como as decorrentes das sequelas da epifisiólise do fêmur proximal, da displasia do quadril da doença de Legg-Perthes-Calvé, podem levar ao desenvolvimento da artrose do quadril. No entanto, em torno de 80% dos indivíduos que desenvolvem essa doença têm uma anatomia óssea considerada normal. Ainda assim, surgiu a hipótese que alterações sutis do fêmur proximal ou do acetábulo, denominadas, respectivamente, cam e pincer, poderiam gerar um contato anormal entre essas estruturas ósseas, desencadear lesão condral e, como consequência, a artrose do quadril. Esse mecanismo foi denominado impacto fêmoro-acetabular. No entanto, a comprovação da relação entre o impacto e a artrose do quadril depende da uniformização dos critérios diagnósticos do cam e do pincer, ainda escassa e variável na literatura. Dessa forma, será possível a definição da prevalência e história natura do impacto fêmoro-acetabular e da sua relação com a artrose do quadril. Objetivo: Avaliar a prevalência do impacto fêmoro-acetabular tipo cam e tipo pincer em uma amostra de indivíduos assintomáticos. Pacientes e Métodos: Foram estudados 106 indivíduos assintomáticos (65 homens e 41 mulheres), com idade entre 20 e 40 anos. A condição determinante para a inclusão no estudo foi à ausência de história de dor no quadril ao longo da vida. Foram obtidas radiografias em ântero-posterior e Dünn 45°. A presença de cam foi determinada por um ângulo alfa, arbitrado, de 55° e a presença de pincer, quando observado o sinal da parede posterior e/ou o sinal de crossover. Resultados: Foi observada prevalência de cam de 29%; o sinal do crossover e da parede posterior ocorreram, respectivamente, em 20% e 29% dos indivíduos estudados. Pelo menos uma das imagens de impacto fêmoro-acetabular estava presente em 65% dos indivíduos da amostra. Conclusão: A prevalência encontrada das imagens de impacto fêmoro-acetabular (65%) está acima daquelas relatadas na literatura. É necessária a ampliação do estudo para confirmar os resultados encontrados e a realização de estudos prospectivos bem controlados para avaliar o papel do cam e do pincer no desenvolvimento da artrose do quadril.Background: Anatomical abnormalities of the proximal femur or the acetabulum, such as those resulting from the consequences of slipped epiphyses of the proximal femur, the hip dysplasia of Legg-Calve-Perthes disease, could lead to the development of hip osteoarthrosis. Nevertheless, around 80% of individuals who develop this condition have a bone anatomy considered normal. Still, the hypothesis arose that subtle alterations of the proximal femur or the acetabulum, called, respectively, cam and pincer, could generate an abnormal contact between these bony structures, triggering chondral lesion and as a consequence, arthritis of the hip. This mechanism has been named femoroacetabular impingement. Nevertheless, evidence of the relationship between the impact and osteoarthritis of the hip depends on the standardization of diagnostic criteria of cam and pincer, still scarce and variable in the literature. Thus it will be possible to define the prevalence and natural history of femoroacetabular impingement and its relationship with hip osteoarthrosis. Aim: To determine the prevalence of cam-type and pincer-type femoroacetabular impingements in asymptomatic subjects. Patients and Methods: Were studied 106 asymptomatic subjects (65 males and 41 females) aged between 20 and 40 years. The determining condition for inclusion in the study was the absence of history of hip pain throughout life. Radiographs were obtained in anteroposterior pelvic view and Dunn 45° view. The presence of cam was determined by an angle alpha, arbitrated, 55 ° and the presence of pincer when the observed the posterior wall and / or crossover signs. Results: A prevalence of 29% of cam, and 20% and 29% of crossover sign and posterior wall sign respectively was found. At least, one of those radiographic signs of femoroacetabular impingement was found in 65% (68) of the cases. Conclusion: In conclusion, the prevalence of images of femoroacetabular impingement (65%) is above those reported in the literature. Increase of the study is necessary to verify the results found, and the performance of well-controlled prospective studies to evaluate the role of the cam and pincer in the development of osteoarthritis of the hip

Total hip arthroplasty: a still evolving technique

ABSTRACT It has been advocated that total hip arthroplasty (THA) is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological , fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA

Pevalence of radiographic findings os femoroacetabular impingement in asymptomatic adults

Objetivo: determinar a prevalência dos sinais radiográficos de impacto femoroacetabular (IFA) em adultos assintomáticos e correlacionar com dados do exame físico. Métodos: estudo transversal, com 82 voluntários, 164 quadris, selecionados por conveniência, assintomáticos, entre 40 e 60 anos de idade. Esses foram submetidos à anamnese e exame clínico do quadril, exame radiográfico com três incidências, antero-posterior (AP) de bacia, Dunn a 45° e falso perfil de Lequesne de cada quadril, para mensuração das variáveis. Aferimos o ângulo alfa, offset anterior do colo femoral, ângulo cérvico diafisário, ângulo CE de Wiberg, índice acetabular, ângulo de Sharp, além dos sinais do cruzamento, da espinha isquiática e da parede posterior. Resultados: nossa amostra foi formada por 66% de mulheres, com média de idade de 50,4 anos. O ângulo alfa médio foi de 45.10º, DP = 8.6. 25% dos quadris apresentaram ângulo alfa maior ou igual a 50°; entre os homens a prevalência foi 34% e entre as mulheres 11%. Encontramos sinais radiográficos indicativos de impacto femoroacetabular em 42,6% dos quadris, sejam eles femorais ou acetabulares, e o aumento do ângulo alfa esteve relacionado com o decréscimo na rotação interna do quadril (p < 0,001). Conclusão: Os achados radiográficos de impacto femoroacetabular em pacientes assintomáticos foram frequentes na amostra estudada. O aumento do ângulo alfa esteve relacionado com o decréscimo da rotação interna.Objective: To determine the prevalence of radiographic signs of femoroacetabular impingement (FAI) in asymptomatic adults and correlate them with data from physical examinations. Methods: We conducted a cross-sectional study with 82 asymptomatic volunteers, 164 hips, between 40 and 60 years of age, selected by convenience. They were submitted to anamnesis and clinical examination of the hip, anteroposterior (AP) pelvis radiographs with three incidences, Dunn 45º and Lequesne false profile of each hip, to measure the variables. We measured the alpha angle, anterior offset of the femoral neck, cervical diaphyseal angle, CE angle of Wiberg, acetabular index, Sharp angle, and the crossing, ischial spine and posterior wall signs. Results: Our sample consisted of 66% women, mean age of 50.4 years. The average alpha angle was 45.10º, SD = 8.6. One quarter of the hips showed alpha angle greater than or equal to 50º; among men the prevalence was 34%, and among women, 11%. We found indicative radiographic signs of femoroacetabular impingement in 42.6% of hips, whether femoral or acetabular, and the increased alpha angle was related to the decrease in hip internal rotation (p < 0.001). Conclusion: The radiographic findings of femoroacetabular impingement in asymptomatic patients were frequent in the studied sample. The increase in alpha angle was associated with decreased internal rotation

Pevalence of radiographic findings os femoroacetabular impingement in asymptomatic adults

Objetivo: determinar a prevalência dos sinais radiográficos de impacto femoroacetabular (IFA) em adultos assintomáticos e correlacionar com dados do exame físico. Métodos: estudo transversal, com 82 voluntários, 164 quadris, selecionados por conveniência, assintomáticos, entre 40 e 60 anos de idade. Esses foram submetidos à anamnese e exame clínico do quadril, exame radiográfico com três incidências, antero-posterior (AP) de bacia, Dunn a 45° e falso perfil de Lequesne de cada quadril, para mensuração das variáveis. Aferimos o ângulo alfa, offset anterior do colo femoral, ângulo cérvico diafisário, ângulo CE de Wiberg, índice acetabular, ângulo de Sharp, além dos sinais do cruzamento, da espinha isquiática e da parede posterior. Resultados: nossa amostra foi formada por 66% de mulheres, com média de idade de 50,4 anos. O ângulo alfa médio foi de 45.10º, DP = 8.6. 25% dos quadris apresentaram ângulo alfa maior ou igual a 50°; entre os homens a prevalência foi 34% e entre as mulheres 11%. Encontramos sinais radiográficos indicativos de impacto femoroacetabular em 42,6% dos quadris, sejam eles femorais ou acetabulares, e o aumento do ângulo alfa esteve relacionado com o decréscimo na rotação interna do quadril (p < 0,001). Conclusão: Os achados radiográficos de impacto femoroacetabular em pacientes assintomáticos foram frequentes na amostra estudada. O aumento do ângulo alfa esteve relacionado com o decréscimo da rotação interna.Objective: To determine the prevalence of radiographic signs of femoroacetabular impingement (FAI) in asymptomatic adults and correlate them with data from physical examinations. Methods: We conducted a cross-sectional study with 82 asymptomatic volunteers, 164 hips, between 40 and 60 years of age, selected by convenience. They were submitted to anamnesis and clinical examination of the hip, anteroposterior (AP) pelvis radiographs with three incidences, Dunn 45º and Lequesne false profile of each hip, to measure the variables. We measured the alpha angle, anterior offset of the femoral neck, cervical diaphyseal angle, CE angle of Wiberg, acetabular index, Sharp angle, and the crossing, ischial spine and posterior wall signs. Results: Our sample consisted of 66% women, mean age of 50.4 years. The average alpha angle was 45.10º, SD = 8.6. One quarter of the hips showed alpha angle greater than or equal to 50º; among men the prevalence was 34%, and among women, 11%. We found indicative radiographic signs of femoroacetabular impingement in 42.6% of hips, whether femoral or acetabular, and the increased alpha angle was related to the decrease in hip internal rotation (p < 0.001). Conclusion: The radiographic findings of femoroacetabular impingement in asymptomatic patients were frequent in the studied sample. The increase in alpha angle was associated with decreased internal rotation