Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hip 719 articles


LCPD: Reduced Range of Motion Resulting From Extra- and Intraarticular Impingement

Moritz Tannast MD, Markus Hanke, Timo M. Ecker MD, Stephen B. Murphy MD, Christoph E. Albers MD, Marc Puls PhD

Legg-Calvé-Perthes disease (LCPD) often results in a deformity that can be considered as a complex form of femoroacetabular impingement (FAI). Improved preoperative characterization of the FAI problem based on a noninvasive three-dimensional computer analysis may help to plan the appropriate operative treatment.

Reliability of a Complication Classification System for Orthopaedic Surgery

Ernest L. Sink MD, Michael Leunig MD, Ira Zaltz MD, Jennifer Claire Gilbert MS, John Clohisy MD

Quality of health care and safety have been emphasized by various professional and governmental groups. However, no standardized method exists for grading and reporting complications in orthopaedic surgery. Conclusions regarding outcomes are incomplete without a standardized, objective complication grading scheme applied concurrently. The general surgery literature has the Clavien-Dindo classification that meets the above criteria.

Surgical Technique: A Percutaneous Method of Subcutaneous Fixation for the Anterior Pelvic Ring: The Pelvic Bridge

Timothy G. Hiesterman DO, Brian W. Hill MD, Peter A. Cole MD

Management of pelvic ring injuries using minimally invasive techniques may be desirable if reduction and stability can be achieved. We present a new technique, the anterior pelvic bridge, which is a percutaneous method of fixing the anterior pelvis through limited incisions over the iliac crest(s) and pubic symphysis.

Clinical Stability of Slipped Capital Femoral Epiphysis does not Correlate with Intraoperative Stability

Kai Ziebarth MD, Stephan Domayer MD, Theddy Slongo MD, Young-Jo Kim MD, PhD, Reinhold Ganz MD

The most important objective of clinical classifications of slipped capital femoral epiphysis (SCFE) is to identify hips associated with a high risk of avascular necrosis (AVN) — so-called unstable or acute slips; however, closed surgery makes confirmation of physeal stability difficult. Performing the capital realignment procedure in SCFE treatment we observed that clinical estimation of physeal stability did not always correlate with intraoperative findings at open surgery. This motivated us to perform a systematic comparison of the clinical classification systems with the intraoperative observations.

Preoperative Three-dimensional CT Predicts Intraoperative Findings in Hip Arthroscopy

Benton E. Heyworth MD, Mark M. Dolan MD, Joseph T. Nguyen MPH, Neal C. Chen MD, Bryan T. Kelly MD

Currently, plain radiographs and MRI are the standard imaging modalities used for diagnosing femoroacetabular impingement (FAI) and preoperative planning for arthroscopic treatment of FAI. The value of three-dimensional (3D) CT for these purposes is unclear.

Edge Loading Has a Paradoxical Effect on Wear in Metal-on-Polyethylene Total Hip Arthroplasties

William H. Harris MD, DSc

Edge wear is an adverse factor that can negatively impact certain THAs. In some metal-on-metal THAs, it can lead to adverse tissue reactions including aseptic lymphocytic vasculitis-associated lesions and even to pseudotumor formation. In some ceramic-on-ceramic THAs, it can lead to squeaking and/or stripe wear. Edge wear in metal-on-metal and ceramic-on-ceramic THAs can also be associated with accelerated wear across the articulation of these joints.

Do Survival Rate and Serum Ion Concentrations 10 Years After Metal-on-Metal Hip Resurfacing Provide Evidence for Continued Use?

Albrecht Hartmann MD, Jörg Lützner MD, Stephan Kirschner MD, Wolf-Christoph Witzleb MD, Klaus-Peter Günther MD

Owing to concerns attributable to problems associated with metal-on-metal bearing surfaces, current evidence for the use of hip resurfacing is unclear. Survival rates reported from registries and individual studies are controversial and the limited long-term studies do not conclusively allow one to judge whether hip resurfacing is still a reasonable alternative to conventional THA.

Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients

Donald W. Howie PhD, MBBS, FRACS, Kerry Costi BA, Margaret A. McGee BSc, MPH, Angela Standen RN, Lucian B. Solomon MD, PhD, FRACS

Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.

Do Joint Registries Report True Rates of Hip Dislocation?

Peter A. Devane MB, ChB, Philip J. Wraighte MB, ChB, David C. G. Ong MBBS, J. Geoffrey Horne MB, ChB

Despite advances in primary THA, dislocation remains a common complication. In New Zealand (NZ), dislocations are reported to the National Joint Registry (NJR) only when prosthetic components are revised in the treatment of a dislocation. Closed reductions of dislocated hips are not recorded by the NJR.

Blood Loss in Cemented THA is not Reduced with Postoperative Versus Preoperative Start of Thromboprophylaxis

Pål O. Borgen MD, Ola E. Dahl MD, PhD, Olav Reikerås MD, PhD

Thrombin formation commences perioperatively in orthopaedic surgery and therefore some surgeons prefer preoperative initiation of pharmacologic thromboprophylaxis. However, because of the potential for increased surgical bleeding, the postoperative initiation of thromboprophylaxis has been advocated to reduce blood loss, need for transfusion, and bleeding complications. Trials on timing of thromboprophylaxis have been designed primarily to detect thrombotic events, and it has been difficult to interpret the magnitude of blood loss and bleeding events owing to lack of information for bleeding volume and underpowered bleeding end points.