Leg and Femoral Neck Length Evaluation Using an Anterior Capsule Preservation Technique in Primary Direct Anterior Approach Total Hip Arthroplasty

Background Achieving correct leg and femoral neck lengths remains a challenge during total hip arthroplasty (THA).  Several methods for intraoperative evaluation and restoration of leg length have been proposed, and each has inaccuracies and shortcomings.  Both the supine positioning of a patient on the operating table during the direct anterior approach (DAA) THA and the preservation of the anterior capsule tissue  are simple, readily available, and cost-effective strategies that can lend themselves well as potential solutions to this problem. Technique The joint replacement is performed through a longitudinal incision (capsulotomy) of the anterior hip joint capsule, and release of the capsular insertion from the femoral intertrochanteric line. As trial components of the prosthesis are placed, the position of the released distal capsule in relationship to its original insertion line is an excellent guide to leg length gained, lost, or left unchanged. Methods The radiographs of 80 consecutive primary THAs were reviewed which utilized anterior capsule preservation and direct capsular measurement as a means of assessing change in leg/femoral neck length. Preoperatively, the operative legs were 2.81 +/- 8.5 mm (SD) shorter than the nonoperative leg (range: 17.7 mm longer to 34.1 mm shorter).  Postoperatively, the operative legs were 1.05 +/- 5.64 mm (SD) longer than the nonoperative leg (range: 14.9 mm longer to 13.7 mm shorter). Conclusion The preservation and re-assessment of the native anterior hip capsule in relationship to its point of release on the femur is a simple and effective means of determining leg/femoral neck length during DAA THA

Revision total hip arthroplasty using the Zweymuller femoral stem

Background: A variety of femoral stem designs have been reported to be successful in revision total hip arthroplasty without consensus as to optimal design. We evaluated the clinical and radiographic outcomes in a consecutive series of femoral revisions using a wedge-shape, tapered-stem design at medium and long-term follow-up. Materials and methods: We performed a retrospective review of clinical and radiographic outcomes of twenty-eight consecutive femoral revisions arthroplasties, which were done using the Zweymuller femoral stem. Results: The mean follow-up was 7.4 years (range 2-15 years). No stem re-revision was necessary. All stems were judged to be stable by radiographic criteria at the most recent follow-up. The final mean Harris hip score was 90. There was no difference in Harris hip scores, implant stability, or radiological appearance (distal cortical hypertrophy or proximal stress shielding) of the implants between medium-term (mean 5.7 years) and long-term (mean 12.4 years) follow-up. Conclusions: We found the Zweymuller femoral stem design to be durable for revision hip arthroplasty when there is an intact metaphyseal-diaphyseal junction for adequate press-fit stability at surgery. © Springer-Verlag 2008

Total Hip Lithiasis: A Rare Sequelae of Spilled Gallstones

Laparoscopic cholecystectomy is a surgical treatment for acute cholecystitis or symptomatic cholelithiasis. One potential complication, the spillage of gallstones into the peritoneal cavity, can form a nidus for infection and may be associated with hepatic, retroperitoneal, thoracic, and abdominal wall abscesses. We report a case of a patient presenting with a right iliopsoas abscess and an infected right hip prosthesis status postlaparoscopic cholecystectomy. A CT demonstrated that the acetabular shell was overmedialized and perforated through the medial wall. The patient was taken to the operating room for explantation of components. A collection of gallstones was identified deep to the acetabulum during the explantation. The case highlights the importance of avoiding overmedialization of the acetabular component, which can provide a direct route for infection into the hip joint