Leg length discrepancy after total hip arthroplasty (THA) sometimes causes significant patient dissatisfaction. In consideration of the leg length after THA, leg length discrepancy is often measured using anteroposterior (AP) pelvic radiography. However, some cases have discrepancies in femoral and tibial lengths, and we believe that in some cases, true leg length differences should be taken into consideration in total leg length measurement. We report the lengths of the lower limb, femur, and tibia measured using the preoperative standing AP full-leg radiographs of the patients who underwent THA. From August 2013 to February 2017, 282 patients underwent standing AP full-leg radiography before THA. Of the patients, 33 were male and 249 were female. The mean age of the patients was 65.7±9.4 years. We measured the distances between the center of the tibial plafond and lesser trochanter apex (A-L), between the femoral intercondylar notch and lesser trochanter (K-L), and between the centers of the tibial plafond and intercondylar spine of the tibia (A-K) on standing AP full-leg radiographs before THA operation. We examined the differences in leg length and the causes of these discrepancies after guiding the difference between them.Purpose
Materials and methods
We occasionally come across cortical atrophy of the femur with cemented collarless polished triple-taper stem, a short time after the operation. This study aimed to estimate the radiographs of cemented collarless polished triple-taper stem taken at three, six, twelve, and twenty-four months after the initial operation. Between May 2009 and April 2011, 97 consecutive patients underwent primary total hip arthroplasty and hemiarthroplasty using a SC-stem or C-stem implant. During the 24 month follow-up, radiographic examination was performed on a total of 95 patients (98 hips). Out of those 95 patients, 52 hips had total hip arthroplasty, 45 had osteoarthritis, 5 had idiopathic osteonecrosis, there were two 2 other cases and 46 hips had hemiarthroplasty for femoral neck fractures. The cementing grade was estimated on the postoperative radiographs. The 24 month postoperative radiographs were analyzed for changes in stem subsidence, cortical atrophy and cortical hypertrophy. According to the Gruen zone, cortical atrophy and cortical hypertrophy were classified on the femoral side. We defined no cortical atrophy as grade 0, cortical atrophy less than 1 mm as grade 1, more than 1 mm and less than 2 mm as grade 2, and more than 2 mm as grade 3. We defined Grade 1 as 1 point, Grade 2 as 2 points, and Grade 3 as 3 points. The points in every zone were calculated, and the average per zone was determined.Background
Methods
The aim of this study is to evaluate the effect of three-dimensional (3D) simulation with 3D planning software ZedKnee® (ZK) in total knee arthroplasty (TKA). The participants in this study were all TKA patients whose operations were simulated by using ZK. The alignment of all components was evaluated with the ZK valuation software in postoperative computer tomography. Thirty patients (43 knees) met the inclusion criteria. 6 patients were male and 24 patients were female. The mean age of the 30 patients was 72 years old. Diagnoses for surgery were: osteoarthritis- 40 knees, rheumatoid arthritis- 2 knees and osteonecrosis- 1 knee. TKA was performed using the measured resection technique. The distal femur axis where the intramedullary rod would be inserted was drawn manually on the 3D image. Then, the angle between the distal femoral axis and the mechanical axis was measured. The rotational angles of the femoral components were determined from the automatically calculated angle between the posterior condylar axis and the surgical epicondylar axis (SEA) by using ZK. The ZK data used during the operation was the posterior condylar angle, the angle between the distal femoral axis and the mechanical axis and implant size.Aim
Materials and methods
Direct anterior approach (DAA) is one of the best way to the hip joint for prevention of post-operative dislocation. We have applied this method as minimum invasive surgery (MIS) to more than two hundred developmental dysplastic hip of Japanese patients in total hip arthroplasty (THA) and there is no post-operative dislocation within three years of last observation carried forward (LOCF). The reason of this benefit is derived from the accuracy of cup positioning and keeping good muscle balance. But the learning curve is very important and some technical pitfalls are there in this approach. We have chosen thirty four patients that the duration of operating time more than one and half hours and loss of blood more than five hundred gram in hour series. The most important factors of the difficulties are the combinations of shortening of femoral neck, especially Perthes like deformity of developmental deformities of the hip joint (DDH) and widening of pelvic bone for the reason of insufficiency working spaces and the difficulties of broaching insertion (8/34). The second factor is the contracture of hip and knee joints combinations for the difficulties of lift up the proximal femur as broaching stem (3/34). The obesity, Body Mass Index (BMI) above thirty is not the reason of difficulties of women in our series. DAA can be extended to Smith-Petersen approach and very useful technique for primary THA in Japanese dysplastic hip patients.
The Dall approach is a modified anterolateral approach with osteotomy of the anterior part of the greater trochanter. This approach relatively preserves the soft tissue tension during total hip arthroplasty (THA). We insert the stem and select a ball neck size so as to have a stable hip which will not dislocate easily during the trial reduction. The aim of this study is to evaluate the adequacy of this method, to measure leg length discrepancy and offset discrepancy at postoperative radiographs. We selected patients for inclusion in this study from those who have more than a 120 degree of affected hip flection angle, the opposite hip is almost normal with a low leg length discrepancy (primary OA, osteonecrosis, Crowe 1 secondary OA, femoral neck fracture). All THA were performed with cement fixation using an alignment guide to ensure accurate acetabular positioning. The ball head's diameter used were all 26mm. From September 2011 to October 2013, 22 patients met inclusion criteria among 103 THA. The mean age for 22 subjects was 66.6±12 years. The mean flexion angle of preoperative hip joints was 127.2±6.1 degrees. The cup inclination was 43.8° ± 3.5°. Anteversion was 11.8°±6°. The mean preoperative leg length discrepancy was 5.8mm±6.3mm. The mean postoperative leg length discrepancy was 0.7±3.5mm. The mean postoperative offset discrepancy was 0.7±6.6mm. There were no dislocations in this series of 103 cases. Discussion. Dislocation and leg length discrepancies are major complications following a total hip arthroplasty. A good range of motion of the preoperative hip joint is considered a high risk dislocation factor. The Dall approach with minimal release of soft tissue related to a tension of hip joint offers maximal stability and the ability to accurately restore leg length.
We occasionally came across cortical atrophy of femurs with cemented collarless polished triple-taper stem in a short term period. This study aimed to estimate radiographs of cemented collarless polished triple-taper stem taken 6 months after the initial operation. Between May 2009 and April 2011, 97 consecutive patients underwent primary total hip arthroplasty and hemiarthroplasty using SC-stem or C-stem implants. At the 6 month follow-up, a radiographic examination was performed on 70 patients (71 hips). 44 hips had Total Hip Arthoplasty, 35 had osteoarthritis, 5 had idiopathic osteonecrosis, 2 had other diseases and 27 hips had hemiarthroplasty for femoral neck fractures. The postoperative radiographs were used to estimate the cementing grade. Then the 6 month postoperative radiographs were analyzed for changes in stem subsidence, cortical atrophy and cortical hypertrophy. According to the system of Gruen- cortical atrophy and cortical hypertrophy were classified on the femoral side. We defined no cortical atrophy as grade 0, cortical atrophy less than 1 mm as grade 1, more than 1 mm and less than 2 mm as grade 2, more than 2 mm as grade 3.Background
Methods
Surgical site infection (SSI) is an infrequent but serious complication of total joint arthroplasty (TJA). Orthopaedic SSI causes substantial morbidity, prolonging the hospital stay by a median of 2 weeks, doubling the rates of rehospitalization, and more than tripling overall healthcare costs. Colonization with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) is known to be associated with an increased risk of subsequent SSI. Carriers are two to nine times more likely to acquire S. aureus SSIs than non-carriers. Screening of the nose and throat for MRSA colonization and preoperative patient decolonization have been shown to decrease the incidence of subsequent MRSA infection. The aim of this study was to investigate the association between the results of MRSA colonization screening and the incidence of SSI in our hospital. Between June 2007 and June 2010, 238 patients were admitted for TJA, among whom 235 underwent preoperative assessment that included screening of the nose and throat for MRSA colonization. Fifty-nine of these patients underwent total hip arthroplasty (THA), 69 underwent total knee arthroplasty (TKA), 6 underwent unilateral knee arthroplasty (UKA), and 101 underwent bipolar hip prosthesis arthroplasty (BPH). The mean age of the patients was 72.7 (49–95) years and the male to female ratio was 1:3.8. We analyzed these patients retrospectively, and determined the site of colonization, eradication prior to surgery, and subsequent development of SSI in the year after surgery. SSI was defined according to the criteria established by the Centers for Disease Control and Prevention.Purpose
Materials and Methods
