Апр 03

Revision Total Hip Arthroplasty

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Currently over 20,000 revision hip arthroplasties are performed in North America per year. Longer life expectancy, implantation of prosthetic hips in younger and active patients, and the increase in the number of patients with hip arthroplasty in place for decades are some of the reasons for the rise in the incidence of revision THA. Hip arthroplasty may fail and necessitate revision for many reasons (Table 15-1). The goal of revision THA, as for primary surgery, is to relieve the patients’ symptoms and restore function. The main challenge of revision surgery, however, is to accomplish these objectives in the setting of compromised bone stock, poor soft tissue, and the possible presence of infection. Hence, both planning and execution of revision hip arthroplasty can be very different and in many occasions much more difficult than primary arthroplasty. Extensile surgical approaches, more sophisticated prosthetic devices, and more restricted postoperative protocols are common in revision arthroplasty. Because of the above noted challenges, the outcome of revision arthroplasty in terms of improvement in function (as measured by validated instruments), complication rate, and longevity of the prosthesis are inferior compared with primary THA.

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автор: Романтик

Апр 03

Total hip arthroplasty (THA) is among the most commonly performed and successful orthopaedic operations. In 2003 there were over 230,000 primary THAs performed in the United States alone, and in terms of quality-adjusted life years gained, THA is one of the most cost-effective health care interventions available. Despite the overwhelming success of THA for the treatment of end-stage hip disease, failures do occur, and the patient with a painful THA is one of the most difficult challenges for the orthopaedic surgeon to evaluate and treat. The purpose of this chapter is to review the workup and evaluation of the painful THA.

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автор: Романтик

Апр 03

Total hip arthroplasty (THA) is extremely successful for the restoration of function and relief of pain resulting from arthritic conditions of the hip. However, complications can and do occur after THA. This chapter reviews the major complications associated with THA, which include (but are not limited to) the following: infection, neurovascular injury, thromboembolism, instability, heterotopic ossification, leg-length discrepancy, component fracture or failure, and the possibility of systemic complications. Each of these complications will be reviewed and methods of prevention and management will be discussed.

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автор: Романтик

Апр 03

Hip Hemiarthroplasty

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With historical roots dating back nearly a century, hip hemiarthroplasty remains one of the most commonly performed orthopedic operations still in use today. Most hip hemiarthroplasty procedures are carried out for femoral neck fractures in elderly patients. Over the decades, however, hemiarthroplasty has been used for many other indications including initial usage for osteoarthritis and as a temporizing measure for the young patient with osteonecrosis. Hemiresurfacing procedures have been used to provide a conservative alternative to total hip arthroplasty in young patients. As longer-term data have become available, the future trends in the use of hip hemiarthroplasty and more specifically hemiresurfacing arthroplasty remain to be seen. This chapter outlines three categories of indications and patient types in which hemiarthroplasty is widely used. First is the use of hemiarthroplasty for the treatment of acute femoral neck fracture. Second, the use of hip hemiarthroplasty for indications other than femur fracture is reviewed. Third, the history and continued use of hemiresurfacing techniques will be analyzed. The future of this technique for indications other than proximal femur fracture will be written by long-term studies comparing and contrasting the effectiveness of hemiarthroplasty with the now available long-term results of total hip arthroplasty in these three patient groups.

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автор: Романтик

Апр 03

Osteotomies Around the Hip

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Osteotomies Around the Hip
Over the past decade there has been a renewed focus on joint preservation surgery of the hip. This is owing to an enhanced understanding of the pathogenesis of degenerative hip disease, improved diagnostic imaging modalities, refined patient selection criteria, and more sophisticated surgical techniques. Perhaps most important is an appreciation of the significance of prearthritic and early arthritic hip symptoms that commonly occur before irreversible joint deterioration. These early symptoms provide a window of opportunity for surgical intervention to remedy the underlying hip abnormality and to improve the prognosis of early hip disease. The goals of joint preservation surgery are to alleviate hip symptoms, improve the functional capacity of the hip, and delay or prevent the biologic cascade of degenerative hip disease. Osteotomy surgery about the hip is one of the mainstay joint preservation strategies and will continue to play a major role in the expanding field of hip preservation surgery. Nevertheless, optimal clinical results of osteotomy surgery are realized only through careful patient selection, detailed preoperative planning, accurate surgical procedures, and supervised patient rehabilitation. The goal of this chapter is to summarize the essential concepts of hip osteotomy surgery. The fundamentals of patient evaluation and the basics of osteotomy procedures will be presented for the most common structural disorders of the hip.

автор: Романтик

Апр 03

Head-Sparing Procedures for Osteonecrosis of the Femoral Head

It is estimated that 300,000 to 600,000 people have osteonecrosis in the United States and that osteonecrosis (ON) of the femoral head accounts for approximately 10% of the more than 250,000 total hip replacements performed annually. 1 Patients with osteonecrosis of the femoral head are commonly in their 30s and 40s at the time of onset, and nearly 50% have bilateral disease. Results of total hip arthroplasty in this patient group have been inferior to other diagnostic groups. 2 These factors have led to the development of conservative surgical methods aimed at sparing the femoral head. However, the efficacy and the proper indications for these surgical interventions such as core decompression (with or without grafting), osteotomy, and hemiresurfacing arthroplasty are still debated. The preferred treatment varies according to the severity, extent of the disease, condition of the acetabular articular cartilage, and age of the patient. 2

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автор: Романтик

Апр 03

The list of miscellaneous disorders that can affect the hip is lengthy. This section addresses some of the unique and more troublesome problems. Patients can present with symptoms of pain and functional loss or may simply present with a radiographic abnormality discovered incidentally (Table 7-1). Some of these problems are rare and can be difficult to treat. Some disorders have characteristic radiographic features that can be diagnostic (Table 7-1).

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автор: Романтик

Апр 03

Posttraumatic Conditions

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Trauma to the hip can lead to long-term dysfunction from posttraumatic arthritis, osteonecrosis, malunion, and nonunion. End-stage arthritis may develop quickly after the injury or it may develop years later. In many patients, treatment involves removal of the current hardware and conversion to total hip arthroplasty. Osteoporosis, bone loss, and heterotopic bone formation complicate total hip arthroplasty. Hip salvage via other procedures such as refixation of the fracture, valgus osteotomy, or femoral head reshaping may be considered for patients with a viable femoral head.
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автор: Романтик

Апр 03

Developmental Dysplasia

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Michael Skutek
Steven J. Macdonald
Developmental dysplasia of the hip (DDH) is one of the most common neonatal orthopaedic problems, and it has variable morphologic patterns. The term refers to an abnormal relationship between the femoral head and the acetabulum and includes the fetal, neonatal, and infantile periods. It results in anatomic abnormalities leading to increased contact pressure in the joint and, eventually, coxarthrosis. Abnormal mechanical forces on the head of the femur may contribute to DDH; however, the primary cause is still unknown. The pathomorphologic appearance commonly includes an increased femoral neck/shaft angle, increased anteversion of the proximal femur and a shallow acetabulum. In untreated or unsuccessfully treated cases, pain and disability commonly necessitate reconstructive surgery or hip replacement at some time during adult life. However, many patients with hip dysplasia become symptomatic before the development of severe degenerative changes because of abnormal hip biomechanics, hip instability, impingement, or associated labral pathology. Several nonarthroplasty treatment options are available. The primary deformity is most commonly acetabular; therefore, for many patients; a reconstructive osteotomy that restores more nearly normal pelvic anatomy is often considered. Total hip arthroplasty for the treatment of DDH can be complex with technical challenges on both the acetabular and femoral sides.
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автор: Романтик

Апр 03

Osteonecrosis of the Femoral Head

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Osteonecrosis of the Femoral Head
Frank A. Petrigliano
Jay R. Lieberman
Osteonecrosis (ON) of the femoral head is a progressive disease that if left untreated often results in subchondral fracture, collapse of the femoral head, and debilitating arthrosis. The precise pathophysiology of ON remains unclear; however, it appears to be the final common pathway of either traumatic or atraumatic factors that compromise the tenuous circulation of the femoral head. The disease typically affects young patients, thereby significantly impacting both work and leisure activity. Accordingly, early diagnosis and treatment are crucial to limit the progression of ON and the subsequent need for total hip arthroplasty. In many cases, however, diagnosis is made in later stages of the disease, when femoral head–preserving treatments are no longer effective. This chapter discusses the natural history of ON, the current diagnostic and treatment options for both early and late stages of the disease, and the limitations of these existing therapies.

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автор: Романтик

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