Trial femoral head loss in to the soft tissues of pelvis during primary total hip replacement: a case report

The loss of trial femoral head in the soft tissues is a rare per operative complication in total hips replacement. We report the loss of the femoral head in surrounding hip joint soft tissues and unsuccessful attempts to locate and remove it. Surgeons should be aware of such complication as trial femoral heads usually are made from non radiolucent material and cannot be detected by regular x-ray examination during surgery. The industry should consider manufacturing trial femoral heads from x-ray visible material

The Soft Tissues in Osteoarthritis and Arthroplasty of the Hip

Ultrasonography as a tool measuring the anterior capsular distance in THA was so far not described nor validated. Comparing the measurements of the capsular distance set with a caliper/ruler with those performed with ultrasonography on a THA model demonstrated a high correlation between measurements. The effect of experience of ultrasonography in THA was also evaluated comparing the first and last series of examinations. It was shown that intra/ inter observer agreement increased with increasing number of examinations. The pain in osteoarthritis (OA) and its relation to the elastic properties of the hip joint capsule was analyzed. In OA patients intracapsular pressure and capsular elasticity, i.e. compliance, was measured. Pain assessment, radiographic evaluation and ultrasonography measuring the anterior capsular distance of the hip joint were performed prior to these pressure measurements. No correlation was found between pain and intracapsular pressure in these OA hips. However, there was an inverse correlation between radiographic severity of OA and elasticity of the hip joint capsule. These findings indicate an increase in intracapsular pressure in early stages of OA and lower or no pressure in late OA. This observed lack of pain/pressure correlation was not in accordance with previous reports. These measurements were performed after the release of the short rotators. To investigate the effect of the short rotators on intracapsular pressure we investigated the pressure, pain and radiographic grade in OA patients. The pressure was measured in various positions of the hip before and after release of the short rotators. Release of the short rotators did not change the intracapsular pressure in any position except in 45° flexion, in which the pressure increased, nor did we find any correlation between pain and intracapsular pressure. Dislocation after THA is one of the most common postoperative complications. Postoperative intraarticular edema and/or fluid might be contributing factors. Posterior soft tissue repair was suggested to reduce the dislocation rate and decrease the volume of postoperative fluid in the THA hip. THA patients with or without posterior soft tissue repair were analyzed. To evaluate postoperative capsular distension, indicating synovial edema/fluid, US was performed 6 and 12 months after surgery. Posterior soft tissue repair resulted in greater sonographically measured capsular distance 6 months postoperatively, but after 12 months there was no difference in hips with or without posterior soft tissue repair. This finding suggests that the previously postulated idea that posterior soft tissue repair reduces postoperative “dead space can be debated. The role of synovitis and increased intracapsular hydrostatic pressure in the loosening process after THA has gained increased attention. Unrevised, radiographically stable hips that had THA because of osteoarthritis 10 years earlier with 28 or 32 mm femoral heads were analyzed. The correlation between PE wear and sonographically measured capsular distances was estimated. It was found that 32 mm femoral heads were associated with greater wear and greater capsular distance as compared to 28 mm heads. A correlation between linear and volumetric wear and sonographically measured capsular distance was also noted. These findings were observed before radiographic signs of loosening, and indicate that the THA loosening process starts before its radiographic appearance

Short-term outcome after total hip arthroplasty using dual-mobility cup: report from Lithuanian Arthroplasty Register

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked FilesPURPOSE: The purpose of the study was to investigate how the use of dual-mobility cups (DMCs) affected the risk of revision due to dislocation as well as overall risk of revision compared with a conventional total hip arthroplasty (THA) system in the short term. METHODS: A total of 12,657 primary THAs were registered from the start of 2011 to the end of 2014. 620 THAs were with DMCs. For comparison, we included all registered THAs with Exeter cup and a cemented Exeter stem combined with 28-mm femoral head. Patients were followed up with respect to revision and/or death until 1 January 2016. For survival analysis, we used revision as an endpoint. Cox proportional hazards models were used to analyse the influence of various covariates (age, gender, surgical approach, THA model and pre-operative diagnosis). RESULTS: Of the 620 dual-mobility THAs and 2170 Exeter THAs, 100 had been revised. The overall unadjusted cumulative revision rate (CRR) for any reason of revision at five years after surgery was 3.9% in the dual-mobility group and 5.2% in the Exeter group. Cox regression analysis, adjusting for age, gender, THA type, surgical approach and pre-operative diagnosis, showed that the risk of revision was less in patients operated with DMCs and in patients having their operation for osteoarthritis. CONCLUSION: The DM implant had a lower short-term complication rate than a conventional well defined THA. Low dislocation rate suggests that it is a good choice for high risk patients

Femoral neck fractures in Lithuania and Sweden. The differences in care and outcome

Hip fractures constitute a serious and common health problem from both individual and public health perspectives. Unified data collection and comparison between countries is recognised as an effective tool for care improvements. However, the variation in patients' demography, treatment methods and other local cultural aspects in different countries should be considered. The aim of our study was to compare femoral neck fracture patients treated in Kaunas and Lund, concerning functional outcome and quality of life. We investigated 99 patients treated by arthroplasty in Kaunas Clinics and 117 patients in Lund University Hospital. Patients were investigated according to the National Swedish Hip Fracture Register model and were followed up for a period of four months after the injury. The patient's place of residence, mobility, complaints of pain and additional hospital stay were recorded. The EQ-5D questionnaire was used to evaluate quality of life. Patients in Kaunas were significantly younger, had lower ASA grade and were more mobile before trauma and at four moths follow-up. However, when comparing quality of life at four months follow-up between the institutions, Lund patients reported significantly better self care, felt less pain and discomfort, and had less symptoms of anxiety and depression. The difference observed in quality of life rating between institutions might be related to local cultures of the countries and should be considered when comparing the data

Introduction of total knee arthroplasty in Lithuania: Results from the first 10 years

Background and purpose We have previously reported that the first 10 years of hip arthroplasty in Lithuania resulted in a higher cumulative revision rate than that observed in Sweden. We thus compared the corresponding results after introduaction of total knee replacement in Lithuania

Antibiotic Containing Bone Substitute in Major Hip Surgery:A Long Term Gentamicin Elution Study

Objectives: The objective is to present the antibiotic elution from a locally implanted gentamicin containing hydroxyapatite and calcium sulphate bone substitute with an extended follow up of 30 days. We also compare the pharmacokinetics of the ceramic bone substitute with a published study on gentamicin containing poly (methyl methacrylate) (PMMA) bone cement used in primary total hip arthroplasty. Methods: Gentamicin release was measured in the urine for a month and the serum for 4 days in 10 patients operated for trochanteric hip fractures and 10 patients in uncemented hip revisions. 17 patients were followed up at one year and 3 patients at 6 months. Results and Discussion: The gentamicin concentrations measured in serum were low and approximately 100 times less than in urine during the first days, indicating high local concentrations at the implant site. The elution from the biphasic bone substitute showed a stronger burst and higher gentamicin concentrations for the first week compared to that reported for PMMA used in hip arthroplasty. Also, for the bone substitute a complete gentamicin elution was obtained after 30 days, while for the PMMA cement sub-inhibitory MIC levels of gentamicin were still present in urine 60 days past surgery. No infections were detected. Conclusions: A new biphasic bone substitute containing antibiotics could potentially be used to prevent infection in patients treated for trochanteric hip fractures or uncemented hip revisions. The gentamicin elution from the bone substitute is efficient with high initial local gentamicin concentrations and complete release at 30 days

Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture

<p>Abstract</p> <p>Background</p> <p>Hip dislocation after arthroplasty for femoral neck fractures remains a serious complication. The aim of our study was to investigate the dislocation rate in acute femoral neck fracture patients operated with a posterior approach with cemented conventional or dual articulation acetabular components.</p> <p>Methods</p> <p>We compared the dislocation rate in 56 consecutive patients operated with conventional (single mobility) cemented acetabular components to that in 42 consecutive patients operated with dual articulation acetabular components. All the patients were operated via posterior approach and were followed up to one year postoperatively.</p> <p>Results</p> <p>There were 8 dislocations in the 56 patients having conventional components as compared to no dislocations in those 42 having dual articulation components (p = 0.01). The groups were similar with respect to age and gender distribution.</p> <p>Conclusions</p> <p>We conclude that the use of a cemented dual articulation acetabular component significantly reduces the dislocation rates in femoral neck fracture patients operated via posterior approach.</p

Delayed hospitalization increases mortality in displaced femoral neck fracture patients

Background and purpose Reports regarding the relationship between delayed surgery and mortality in femoral neck fracture patients are contradictory. We could not find any study in the literature investigating delayed arrival to hospital and delayed surgery as separate factors affecting mortality in femoral neck fracture patients, which was the purpose of our study

The short rotators do not influence capsular compliance or pain in severe hip osteoarthritis. A randomised controlled trial.

Abstract: A randomised controlled trial was performed to investigate if the short rotators affected the compliance of the capsule in osteoarthritis (OA). 68 OA patients admitted for total hip arthroplasty (THA) were randomised to have their compliance estimated during surgery with either their short rotators intact or released. Radiographic severity of OA, range of motion and pain were assessed in the affected hip before surgery. There was no significant difference in the compliance of the capsule whether the short rotators were intact or released (p= 0.5). Furthermore, there was no significant correlation between pain and capsular compliance (p=0.4 and p=0.5). We found no significant effect of the short rotators on compliance of the hip joint capsule, and no significant correlation between pain and capsular compliance