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Rhee I, Do WS, Park KB, Park BK, Kim HW. Hip-Spine Syndrome in Patients With Spinal Cord Injuries: Hyperlordosis Associated With Severe Hip Flexion Contracture. Front Pediatr 2021; 9:646107. [PMID: 34322459 PMCID: PMC8310997 DOI: 10.3389/fped.2021.646107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Aim: Spinal cord injury (SCI)-related flaccid paralysis may result in a debilitating hyperlordosis associated with a progressive hip flexion contracture. The aim of this study was to evaluate the correction of hip flexion contractures and lumbar hyperlordosis in paraplegic patients that had a history of spinal cord injuries. Methods: A retrospective review was performed on 29 hips of 15 consecutive patients who underwent corrective surgeries for severe hip flexion deformity from 2006 to 2018. The mean age at surgery was 10.1 years (2.7 to 15.8), and the mean follow-up was 68 months (7 to 143). Relevant medical, surgical, and postoperative information was collected from the medical records and radiographs. Results: Improvements were seen in the mean hip flexion contracture (p < 0.001) with 100% hip correction at surgery and 92.1% at the latest follow-up. Mean lumbar lordosis decreased (p = 0.029) while the mean Cobb angle increased (p = 0.001) at the latest follow up. Functional score subdomains of the Spinal Cord Independence Measure, Functional Independence Measure, and modified Barthel activities of daily living (ADL) scores remained the same at the final follow-up. Conclusion: For paraplegic SCI patients, we found an association between treating the hip flexion contracture and indirect correction of their lumbar hyperlordosis. We recommend the surgeon carefully examine the hip pathology when managing SCI-related spinal deformities, especially increased lumbar lordosis.
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Affiliation(s)
- Isaac Rhee
- Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Woo Sung Do
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kun-Bo Park
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byoung Kyu Park
- Department of Orthopedic Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Hyun Woo Kim
- Division of Pediatric Orthopedic Surgery, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Kim MW, Chung YY, Lim SA, Shim SW. Selecting Arthroplasty Fixation Approach Based on Greater Trochanter Fracture Type in Unstable Intertrochanteric Fractures. Hip Pelvis 2019; 31:144-149. [PMID: 31501763 PMCID: PMC6726870 DOI: 10.5371/hp.2019.31.3.144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 12/25/2022] Open
Abstract
Purpose To evaluate the success rate of fixation approaches for greater trochanter (GT) fracture types in those with unstable intertrochnateric fractures. Materials and Methods Forty-four patients who underwent arthroplasty for unstable intertrochanteric fractures between January 2015 and November 2017 and followed-up more than six months were included in this study. The fractures of GT were classified into one of four types (i.e., A, B, C, and D) and fixed using either figure-8 wiring or cerclage wiring according to fracture type. Fractures were type A (n=7), type B (n=20), type C (n=6), and type D (n=11). Type A and B, which are fractures located above the inferior border of GT were fixed using figure-8 wiring and/or adding cerclage wiring. On the other hand, all type C and D fractures, which were located below the inferior border, were fixed using cerclage wiring. Fixation failure was defined as breakage of wire and progressive migration of GT fragment greater than 5 mm on follow-up radiographs. Results The most common GT fracture types were B and D, both of which are longitudinal fractures. The success rates of fixation were 85.7% (6 out of 7 cases) for the treatment of type A, 90.0% (18 out of 20 cases) for the treatment of type B, and 100% for the treatment of types C (6 out of 6 cases) and D (11 out of 11 cases). Conclusion We note high success rates following fixation methods were selected based on the GT fracture type.
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Affiliation(s)
- Min-Wook Kim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Young-Yool Chung
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Sung-An Lim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
| | - Seung-Woo Shim
- Department of Orthopaedic Surgery, Kwangju Christian Hospital, Gwangju, Korea
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Drampalos E, Bayam L, Oakley J, Hemmady M, Hodgkinson J. Symptomatic trochanteric non-union following total hip replacement treated with reattachment combined with two-stage revision surgery of the femoral stem. Ann R Coll Surg Engl 2019; 101:e133-e135. [PMID: 31155900 PMCID: PMC6554573 DOI: 10.1308/rcsann.2019.0048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2019] [Indexed: 11/22/2022] Open
Abstract
We present a case of symptomatic trochanteric non-union following total hip replacement treated initially with a Dall-Miles grip plate. After failure of this treatment, the patient had a two-stage revision. Trochanteric non-union is one of the well-described complications after total hip replacement. It is frequently difficult to treat, while potentially causing weakness, altered gait and instability of the artificial joint. We believe that reattachment of the trochanter combined with a staged revision of the femoral stem using a posterior approach for the second stage could be a valuable technique to be added to the orthopaedic armamentarium for recurrent and symptomatic trochanteric non-unions after primary total hip replacement, particularly after failure to treat with all the other techniques described in literature.
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Affiliation(s)
- E Drampalos
- Manchester University Hospitals, Manchester Royal Infirmary, Manchester, UK
| | - L Bayam
- Manchester University Hospitals, Manchester Royal Infirmary, Manchester, UK
- Sakarya University, Education and Research Hospital, Sakarya, Turkey
| | - J Oakley
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - M Hemmady
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
| | - J Hodgkinson
- Centre for Hip Surgery, Wrightington Hospital, Wigan, UK
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Stewart AD, Abdelbary H, Beaulé PE. Trochanteric Fixation With a Third-Generation Cable-Plate System: An Independent Experience. J Arthroplasty 2017; 32:2864-2868.e1. [PMID: 28552443 DOI: 10.1016/j.arth.2017.04.038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/28/2017] [Accepted: 04/18/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Greater trochanteric fracture/nonunion can be a devastating complication with significant functional impact after total hip arthroplasty, and their fixation remains a challenge because of the significant forces being transmitted as well as the poor bone quality often associated with these fractures. The objective of this study is to investigate the rates of reoperation and trochanteric nonunion using a third-generation cable-plate system at one center. METHODS Thirty-five patients, mean age 72.9 years (range 46-98 years) with 24 women and 11 men, underwent fixation of their fractured greater trochanter using a third-generation cable-plate system. The indications were: periprosthetic fracture (n = 17), complex primary arthroplasty (n = 5), and complex revision arthroplasty (n = 13). Primary outcomes included rates of reoperation and radiographic union. RESULTS At a mean follow-up of 2.5 years, trochanteric union rate was 62.9% with nonunion rate of 31.4%, and fibrous union in 5.7%. In regard to quality of initial apposition, only 40% achieved a perfect bone on bone reduction. Ten patients (28.6%) had evidence of wire breakage. Five patients (14.3%) required reoperation and removal of the internal fixation because of lateral hip pain. CONCLUSION Fixation of the trochanteric fractures remains a challenge with a relatively high reoperation rate. Poor bone quality and capacity to maintain a stable reduction continue to make this complication after total hip arthroplasty a difficult problem to solve.
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Affiliation(s)
- Andrew D Stewart
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Hesham Abdelbary
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada
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Yoon PW, Kim JI, Kim DO, Yu CH, Yoo JJ, Kim HJ, Yoon KS. Cementless total hip arthroplasty for patients with Crowe type III or IV developmental dysplasia of the hip: two-stage total hip arthroplasty following skeletal traction after soft tissue release for irreducible hips. Clin Orthop Surg 2013; 5:167-73. [PMID: 24009901 PMCID: PMC3758985 DOI: 10.4055/cios.2013.5.3.167] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 03/16/2013] [Indexed: 11/15/2022] Open
Abstract
Background Total hip arthroplasty (THA) for severe developmental dysplasia of the hip (DDH) is a technically demanding procedure for arthroplasty surgeons, and it is often difficult to reduce the hip joint without soft tissue release due to severe flexion contracture. We performed two-stage THAs in irreducible hips with expected lengthening of the affected limb after THA of over 2.5 cm or with flexion contractures of greater than 30 degrees in order to place the acetabular cup in the true acetabulum and to prevent neurologic deficits associated with acute elongation of the limb. The purpose of this study is to evaluate the outcomes of cementless THA in patients with severe DDH with a special focus on the results of two-stage THA. Methods Retrospective clinical and radiological evaluations were done on 17 patients with Crowe type III or IV developmental DDH treated by THA. There were 14 women and 3 men with a mean age of 52.3 years. Follow-ups averaged 52 months. Six cases were treated with two-stage THA followed by surgical hip liberalization and skeletal traction for 2 weeks. Results The mean Harris hip score improved from 40.9 to 89.1, and mean leg length discrepancy (LLD) in 13 unilateral cases was reduced from 2.95 to 0.8 cm. In the patients who underwent two-stage surgery, no nerve palsy was observed, and the single one-stage patient with incomplete peroneal nerve palsy recovered fully 4 weeks postoperatively. Conclusions The short-term clinical and radiographic outcomes of primary cementless THA for patients with Crowe type III or IV DDH were encouraging. Two-stage THA followed by skeletal traction after soft tissue release could provide alternative solutions to the minimization of limb shortenings or LLD without neurologic deficits in highly selected patients.
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Affiliation(s)
- Pil Whan Yoon
- Department of Orthopedic Surgery, Seoul National University Boramae Hospital, Seoul, Korea
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Bailey R, Selfe J, Richards J. The role of the Trendelenburg Test in the examination of gait. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328809x452836] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Trochanteric Management for Unstable Intertrochanteric Femoral Fracture in the Elderly Patients. ACTA ACUST UNITED AC 2007. [DOI: 10.12671/jkfs.2007.20.2.129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Whiteside LA, Nayfeh T, Katerberg BJ. Gluteus maximus flap transfer for greater trochanter reconstruction in revision THA. Clin Orthop Relat Res 2006; 453:203-10. [PMID: 17053566 DOI: 10.1097/01.blo.0000246538.75123.db] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We evaluated the results of an operative technique used in five patients (five hips) to reconstruct the greater trochanter with a gluteus maximus flap transfer during revision total hip arthroplasty. We exposed the hip through a posterior approach that split the gluteus maximus in its midsubstance. We then raised a flap from the posterior portion of the gluteus muscle that was elevated proximally to create a triangular muscle flap. The flap was sewn into the gap between the greater trochanter and lateral cortex of the femur and secured to the inner surface of the anterior capsule of the hip. With the hip abducted 10 degrees to 15 degrees, the edges of the gluteus maximus were closed over the flap and the greater trochanter. We compared the results of these patients with those of five patients (five hips) who had the trochanter left unrepaired and those of four patients (four hips) who had excision of the greater trochanter and suture closure of the intervening gap. The flap group had less pain, lower incidence of limp and Trendelenburg sign, and less need for support than the other two groups, but range of motion decreased.
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Hamadouche M, Zniber B, Dumaine V, Kerboull M, Courpied JP. Reattachment of the ununited greater trochanter following total hip arthroplasty. The use of a trochanteric claw plate. J Bone Joint Surg Am 2003; 85:1330-7. [PMID: 12851359 DOI: 10.2106/00004623-200307000-00020] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this retrospective study was to analyze the utility of a trochanteric claw plate in the treatment of an ununited greater trochanter following total hip arthroplasty. METHODS From 1986 through 1999, seventy-two consecutive procedures to reattach an ununited greater trochanter were performed in seventy-one patients. The average age at the time of the index arthroplasty was 66.2 years. The arthroplasty that resulted in the nonunion of the greater trochanter was primary in fifty-four hips, a first revision in sixteen hips, and a second and third revision in one hip each. The mean duration between the hip replacement and the treatment of the nonunion was 8.1 months. The greater trochanter was fixed with the trochanteric plate alone in forty-eight hips and with the plate in conjunction with vertical wires in the remaining twenty-four hips. The average duration of follow-up was 5.1 years. RESULTS Osseous union occurred in fifty-one of the seventy-two hips. There was a persistent nonunion in twelve hips and fibrous consolidation in the remaining nine hips. The mean time to osseous consolidation was 3.7 +/- 2.1 months (range, two to twelve months). The mean Merle d'Aubigné hip score was 16.1 +/- 2.4 points at the time of the latest follow-up. A highly significant improvement in function was achieved only in the group with osseous consolidation (p < 0.0001). The highest rate of osseous union was achieved when vertical wires had been used in conjunction with the claw plate. Union occurred in twenty-one of the twenty-four hips in that group (p = 0.025). CONCLUSIONS Nonunion of the greater trochanter following total hip arthroplasty can be successfully treated with a trochanteric claw plate. The use of adjunctive vertical wires results in better osseous contact and union.
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Affiliation(s)
- Moussa Hamadouche
- Department of Orthopaedic and Reconstructive Surgery (Service A), Centre Hospitalo-Universitaire Cochin-Port Royal, Paris, France.
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Archibeck MJ, Rosenberg AG, Berger RA, Silverton CD. Trochanteric osteotomy and fixation during total hip arthroplasty. J Am Acad Orthop Surg 2003; 11:163-73. [PMID: 12828446 DOI: 10.5435/00124635-200305000-00003] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Once used routinely, trochanteric osteotomy in total hip arthroplasty now is usually limited to difficult primary and revision cases. There are three types: the standard trochanteric osteotomy and its variations, the trochanteric slide, and the extended trochanteric osteotomy. Each has unique indications, fixation techniques, and complications. Primary total hip arthroplasty procedures requiring the enhanced exposure provided by trochanteric osteotomy may be needed in patients with hip ankylosis or fusion, protrusio acetabuli, proximal femoral deformities, developmental dysplasia, or abductor muscle laxity. Trochanteric osteotomies in revision arthroplasties, primarily the extended trochanteric osteotomy, facilitate the removal of well-fixed femoral components, provide direct access to the diaphysis for distal fixation, and enhance acetabular exposure.
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Affiliation(s)
- Michael J Archibeck
- New Mexico Center for Joint Replacement Surgery, New Mexico Orthopaedics, Albuquerque, USA
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Koyama K, Higuchi F, Kubo M, Okawa T, Inoue A. Reattachment of the greater trochanter using the Dall-Miles cable grip system in revision hip arthroplasty. J Orthop Sci 2001; 6:22-7. [PMID: 11289581 DOI: 10.1007/s007760170020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Clinical and radiographic results of trochanteric osteotomy after revision hip arthroplasty in 62 hips were reviewed. The osteotomized fragment had been reattached using the Dall-Miles cable grip system in each hip. The patients' average age at operation was 64.4 years (range, 40-86 years). The average duration of follow-up was 30.0 months (range. 12-60 months). Trochanteric nonunion was found in 19 hips (30.6%). Trochanteric nonunion developed in 14 (38.9%) of 36 hips with each cable attached around the medial cortex bone, in 2 (16.7%) of 12 hips with each cable passed in a drill hole, and in 3 (21.4%) of 14 hips with one cable passed through a hole and the other attached around the medial cortex. Fragmentation developed in 18 hips (29.0%). In 3 of these 18, the fragments had migrated close to the acetabular component. Cable breakage was seen in 4 hips (6.5%), and bone absorption around the cable in the medial cortex was seen in 17 hips (27.4%). There were 16 hips (25.8%) that presented symptoms at the greater trochanter, including spontaneous pain and tenderness. When the Dall Miles cable grip device is used for reattachment of the greater trochanter, attention should be paid to the condition of the trochanteric bed, the tension of the abductor muscles, and to the placement of the cables and the H-shaped grip.
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Affiliation(s)
- K Koyama
- Department Orthopaedic Surgery, Kurume University School of Medicine, Fukuoka, Japan
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