This is an enhanced PDF from The Journal of Bone and Joint Surgery. 1979;61:15-23. ... ondary to congenital dislocation of the hip 1.4Ã¢â¬Â¢Charnley and Feagin ...
arthroplasty. After total hip replacement recurrent dislocation is a serious and ..... to incorrect positioning of prosthetic components, loosening of the trochanter.
Orthopaedic Surgery, Adult ..... ian Orthopaedic Association National Joint Replacement ... Netter et al112 simulated adverse conditions and tested the behav-.
ossification is seen in 5 per cent of hips not previously operated on. Harris noted myositis ossificans in. 14 per cent of patients following total hip replacement.
biocompatible is the titanium alloy extra low interstitial (ELI)2 Tiâ6Alâ4V; its composi- tion is 90 wt% Ti, 6 wt% Al, and 4 wt% V. The optimal properties for this material are produced by hot forging; any subsequent deformation and/or heat treat
Background Total hip replacement is increasingly used in active, ... femoral neck fracture (Garden III or IV) or a secondary total .... Type of total hip arthroplasty.
THE JOURNAL OF BONE AND JOINT SURGERY hemiarthroplasty or revision hip arthroplasty were excluded. A total of 99 patients presented with 101 first-.
Gonzalez Della Valle A, Serota A, Go G, Sorriaux G, Sculco TP, Sharrock NE, et al. Venous thromboembolism .... Yu HT, Dylan ML, Lin J, Dubois RW. Hospitals' ...
Abstract: Instability after total hip arthroplasty (THA) is not a rare occurrence. Numerous factors have been associated with dislocation including surgical approach, implant design, failure to restore proper hip mechanics and soft tissue restraints,
V early osteointegration. On-growth of bone to porous coated prostheses is ... rich femoral component or with the ce- ... total hip arthroplasty in dogs (1, 2). Loo-.
Radiological analysis assessing heterotopic ossification, femoral osteolysis and femoral stem ... following total joint replacement.12 A retrospec- tive study by ...
Total hip replacement (THR) is a very common procedure undertaken in up to 285 000 .... diagnosis can include activity-related pain, aseptic loosening,.
an ideal total hip replacement with a large femoral head and a high head-neck ratio. B: Cam-type impingement in the native hip caused by a reduced femoral head-neck offset and similar impingement in a prosthetic hip with a small femoral head and a sk
575. INTRODUCTION. Total hip replacement (THR) provides a very effective ... arthroplasty, bilateral arthroplasty; those transferred or initially treated at other ...
90% (Schulte et al 1993; Neumann, Freund and SÃËrenson. 1994). Since its ..... Fowler JL, Gie GA, Lee AJC, Ling RSM. .... Clin On/top l993;292: 191-201. VOL.
Oct 24, 2017 - words âtotal hip replacement/hip prosthesisâ were matched with âsciatic nerve palsyâ, .... (2 Girdlestone, 2 arthrodesis, 1. Colonna arthroplasty, 1.
Nov 28, 2014 - Sciatic Nerve Palsy following Total Hip Replacement via. Direct Anterior ... demonstrated numbness below the knee and she was unable.
Dec 9, 2011 - soft tissue under the patella with the clunk syndrome, impinging hypertrophic synovitis ... extensive scar tissue formation as a response to the tissue trauma ..... The chapters in this book were written by a panel of international ...
Department of Orthopedics, Hospital de ClÃnicas de Porto Alegre, Rio Grande do Sul, Brazil. AbstractâHip osteoarthritis (OA) is a degenerative disease, and total hip arthroplasty (THA) is one of the surgical proce- dures of choice to improve the O
... following total hip arthroplasty and rehabilitation. Karen L. Frost, PhD;. 1*. Gina E. Bertocci, PhD;. 2. Craig A. Wassinger, MS, PT;. 3. Michael C. Munin, MD;.
The incidence of dislocation after primary THA varies from 0.6% to. 7%; one review of 16 large series documented 804 dislocations in. 35,894 THAs (2.24%).4 ...
Closed reduction was attempted in the emergency room, ... He was then taken to the operating room of ... posterior dislocations and from dashboard injuries.
Ultrasound screening is widely used in the early diagnosis of developmental dysplasia of the hip (DDH).1 It has been shown to decrease the incidence of late ...
manifestation of hip dislocation after total hip arthroplasty. Material and Method: .... The average leg shortening compared to prior dislocated X-rays was 3.55 cm ...
An analysis of 142 dislocations from a multicentre incidence of dislocation was 2. 1 per cent. Patients mental state, and those undergoing revision operations The
study of 6774 total hip replacements is reported. with neuromuscular disorder, those in a confused are at special risk. The commonest surgical error,
half the patients, was placing the acetabular cup too vertically or too anteverted. A less was placing the femoral component too anteverted. Neither the original pathology nor the to the hip appeared to affect the likelihood of dislocation. The dislocations were divided into early and late, single and recurrent, and the success rate of treatment is described in these groups. One hundred and eleven patients (78.2 per cent) eventually obtained stability. Of those with a single dislocation, 62 per cent remained stable after a single manipulation. Thirty-four per cent ofthe patients required an open operation to achieve stability and It is suggested that, in many cases, open reduction alone is not enough; the mechanical fault needs to be present
I), but very little has The surgeon needs to of achieving stability.
frequency of dislocation (Table been written about the prognosis. know what to do and the chances Table
A retrospective which followed
study was made of all the dislocations total hip replacements performed at the
Royal Orthopaedic Hospital, Birmingham, and the Winford Orthopaedic Hospital, Bristol, between 1965 and 1 977, and at the Coventry and Warwick Hospital, Coventry, between 1 967 and 1 977. In all there were 142 dislocations; their source, and the types of arthroplasty performed
The youngest patient was 3 1 years old at operation, the oldest 87 years old, and the median age 59 years. The ratio of female to male patients was 2.3: 1 All were .
Lewinnek Etienne, Charnley
et a!. Cupic
off the recovery
to snap In
1 8 months
1 2 years or could
3 1 patients
and was most
table, involuntary anaesthesia and, who
M. A. A. Khan, BSc, FRCSEd, Consultant Orthopaedic Surgeon, Walsall General Hospital, Walsall, P. H. Brakenbury, FRCS, Senior Registrar in Accidents and Emergencies, Middlesbrough General Middlesbrough, Cleveland TS5 SAl, England. I. S. R. Reynolds, FRCS, Consultant Orthopaedic Surgeon, General Hospital, Hereford, England.
leaning was the
movements one case,
to cut the toe
forwards from the cause in 38 patients
West Midlands WS1 Hospital, Ayresome
30Y, England. Green Lane,
traced and whose details were obtained from their notes. Precipitating cause. In seven patients, the dislocation was thought to have been present from the time of operation ; it was attributed variously to lifting the
standard positions some measurements
not available. Nevertheless possible; it was decided the
component as excessive if either exceeded 1 5 degrees, and the cup was considered too vertical if the angle it made with the horizontal exceeded 50 degrees. The
Number arthroplasties performed
acetabulum if it was one
was considered to be located centimetre or more superior
too superiorly to the opposite
acetabular cup too anteverted Table
less common (Table femoral components
predispose to dislocation to have no such effect,
patients there first occurred; dislocated,
was no explanation some patients
dislocation in two patients poliomyelitis, Parkinsonism, ( from a prolapsed intervertebral one.
time of their neurological
by dislocation in other
was a revision
operation. there had
hip replacement there
In all, 46 of the been more than
dislocations occurred one operation; 32
14 late. measurements because
used also of dislocation.
of the acetabular was found in the
of the limb.
seemed From case
not to 3935 of
where of these
et al. in
of the orientaby Lewinnek
were early dislocations Technical faults. Accurate (1 978)
were considered; some proved in others the influence could not
cerebrovascular accident leading to hemiplegia. Previous operations on the hip. A third of the patients had had at least one previous operation on the hip. In many
surgical approach the likelihood
in a patient
while cerebral palsy, old and muscle weakness disc) were each present
mental confusion Seven other patients
as to how dislocation woke up with the hip
replacement was done appeared to have no effect on the likelihood of dislocation. Nevertheless, 33 patients with late dislocation had disorders of other joints in the same
established. nature of the
In 10 cases
be definitely with
IV). Often both were incorrectly
usually it was retroversion
anteversion (Table V). In three of the six in whom the hip was excessively loose too much neck had been removed. In one case a piece of
excessive patients femoral
in or out of bed) but rotation was combined
was the commonest or too vertical.
dislocations (1 .9 per cent); from 2527 posterior approaches there was 53 dislocations (2.1 per cent); and from 3 1 2 Ollier’s approaches there were 1 5 dislocations
per The probably
cent). method had little
of after-care effect. Traction,
of the patients
operation was used
“single”, the others Figure 2 that recurrence after late dislocations.
dislocations used had becoming
Incidence various (compare
bed for two days pillow or wedge. used that
and the duration “immobilisation”
is to keep
after operation Tables VI and
in Figure on the (Table
Of the 1 1 1 patients closed methods
who achieved sufficed; two
success rate for closed manipulation 15 of the recurrent dislocations stable after closed manipulation;
or been (78
a stable outcome and of the 48 late
the remainder were manipulated Forty-eight of these 63 were single
once the initial dislocation had was achieved in 1 1 1 of the 1 42 dislocations
It is clear hips from
per cent). Of the 94 early dislocations was achieved in 76 cases (8 1 per cent), ones
and to use an abduction VII showed the methods
of “immobilisation”. did not prevent
subluxation reduced) of the early
is shown influence recurrent
of dislocation in types of replacement with Table III)
and late. Those were labelled
“recurrent”. It can be seen from is encountered more frequently In recurrent cases the interval
first and second type of implant of dislocations
in Figure arbitrarily,
is shown somewhat
five weeks of operation) not recur after reduction
Type arthroplasty Table
dislocation were divided,
of time first
between 3. The likelihood
and the Dislocations
a stable outcome, were self-reduced, under anaesthesia. dislocations, giving
,..-..r-..*. 1 (
Fig. Interval between operation dislocations were within
and initial the first thereafter.
I dislocation. five weeks
As can he seen, 94 and 48 occurred
Fig. 2 Relationship
time of recurrence.
of 62 per cent. Only (23 per cent) became even this success rate is
1 9 patients
closed reduction felt so unstable proceeded
patients with one operation
in 31 of accepted
permanently were infected,
dislocation a stable
142 patients instability; or
dislocated. two had
persistent instability; was performed.
treatment, (21.8 1 8 of
per cent). these had
Of the remaining painful loosening,
1 2 patients and four
in all 1 2 a Girdlestone
suggests hips could
that the be reduced
a mentally and
incidence by greater
greater by (1978),
aetiological factor, (1978) have shown wall design of socket of the femoral neck trochanter Lazansky was noted
against (1970) in only
technique more likely
the and one
femoral prosthesis. The
is emphasised from
implicated in our study have the acetabulum. Over half the here had malposition of the precise methods than were study, Lewinnek et al.
of operation. out
closed reduction a stable outcome
a 44 per dislocation.
of operation back
which method unfortunately
by the fact that time
had hoped to find prevent dislocation;
femoral of the of the
prosthesis. Less common were excessive resection neck of the femur, loosening of the stem, fracture
that the rate of dislocation is increased is anteverted more than 1 5 ± 1 0 degrees,
to his bed
after-care, was most the records
we likely to do not
point. surprisingly, cent
chance of achieving In the unlucky 34 per
cent who require open reduction we suggest that every effort should be made to assess whether there is any error in the placement of the acetabular or fenioral components; and if there is it should be corrected. In the remaining 22 per cent of patients stability was not achieved.
Our thanks are due to the Orthopaedic Surgeons at Birmingham, Bristol thank Mr M. H. M. Harrison for his advice and encouragement throughout considerable help from the Medical Records Departments of the Bristol Orthopaedic Hospital, Birmingham. We also acknowledge the help of Mrs
cases ofdislocation reported acetabular cup. Using more possible in this retrospective
infection). The technical faults most commonly involved
a neurological disorder. The fact that the same hip has been operated on previously also increases the likelihood of dislocation (as well as increasing the risk of
or of a component of the acetabulum, as recorded Beckenbaugh and Ilstrup
details of patient selection and Factors which make dislocation
showed the cup
Loosening of the cup was another and Etienne, Cupic and Charnley the value of using the long posterior in Charnley’s operation. Abutment
horizontal) is more than 40± 1 0 degrees. Retroversion was less frequent (1 3 hips) in our series than in the series reported by Nolan et al. (1975) from the Mayo Clinic.
This study prosthetic
impossible or the prosthetic joint the anaesthetic, that the surgeon
dislocations also were operated on to achieve stability. Table IX lists the operations used in both these groups. Some than
and Coventry, who allowed their patients to be reviewed. We also this project, and for reading the manuscript. We have received Royal Infirmary, Coventry, Warwick Hospital, and the Royal Clark for her secretarial work.
Charnley 1 972
J. The ;54-B:6
Beckenbaugh Surg lAm]
Lewinnek GE, 1 978;60-A:2 McKee
in total Tarr
of Howse of the
J Bone [Br]
hip replacement low-friction after
J Bone and
complications.) J Bone
arthroplasty of total
ofpostoperative by the
of the J Bone
2,01 2 total
J Bone arthroplasty
Nicholson OR. A comparison Joint Surg [Br] l970;52-B:780-l. Nolan DR, Fitzgerald RH Jr, Beckenbaugh [An] I 975 ;57-A:977-8 I. Richards