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Jud L, Rüedi N, Dimitriou D, Hoch A, Zingg PO. High femoral offset as a risk factor for aseptic femoral component loosening in cementless primary total hip arthroplasty. Int Orthop 2024; 48:1217-1224. [PMID: 38388804 PMCID: PMC11001651 DOI: 10.1007/s00264-024-06116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/02/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE Lateralized stems in primary cementless total hip arthroplasty (THA) showed to be associated with aseptic femoral loosening. However, femoral head length also affects femoral offset but was not considered so far. This study analyzed the impact of high femoral offset (hFO) combinations, formed by lateralized stems or large femoral head lengths, on aseptic femoral component loosening. METHODS Retrospective cohort study was performed including all patients that underwent primary cementless THA at our institution between July 2004 and December 2016. Patients were screened for aseptic femoral component loosening and grouped in aseptic loosening (AL) and non-aseptic loosening (nAL) group. Medical records were screened; implant details were noted and classified in hFO and standard femoral offset (sFO) combinations. Supposed risk factors for aseptic loosening were analyzed. RESULTS Two thousand four hundred fifty-nine THA could be included, containing 14 THA (0.6%) with aseptic femoral component loosening. The AL group contained 11 hFO combinations (78.6%), whereas in the nAL group, 1315 hFO combinations (53.8%) were used. Subgroup analysis showed significant difference between two groups for hFO combinations (p = 0.014), age (p = 0.002), NSAR (p = 0.001), and bilateral THA on same day (p = 0.001). The multiple logistic regression analysis showed that hFO combination was the only variable for increased probability of aseptic loosening (OR, 3.7; p = 0.04). CONCLUSION High femoral offset combinations, formed by lateralized stems or large femoral head lengths in our collective of standard straight stems implanted by an anterior approach, show a 3.7-fold increased probability for aseptic femoral component loosening. Adjustment of the postoperative protocol may be considered in these cases to ensure proper stem ingrowth.
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Affiliation(s)
- Lukas Jud
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Nico Rüedi
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Dimitris Dimitriou
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Armando Hoch
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Patrick O Zingg
- Balgrist University Hospital, Department of Orthopedics, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
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Andronic O, Germann C, Jud L, Imhoff FB, Fröhlich S, Scherr J, Spörri J, Zingg PO. How useful are indirect radiographic measurements of hip instability in borderline hip dysplasia? An MRI-based comparison to a healthy cohort. Int Orthop 2024:10.1007/s00264-024-06202-8. [PMID: 38684549 DOI: 10.1007/s00264-024-06202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE Symptomatic hips with borderline hip dysplasia (BHD) morphology pose a challenge in differentiating stable from unstable hips. The current study aims to compare indirect radiographic signs of instability in a symptomatic BHD population to those in a healthy cohort. METHODS The study group consisted of patients with a lateral centre-edge angle (LCEA) with values 18° ≤ LCEA < 25° who underwent corrective periacetabular osteotomy (PAO) and reported an improvement in patient-reported outcome measures (PROMs). The comparison group consisted of a healthy cohort of athletes who did not complain of any hip-related symptoms and who had normal values of their hip morphological parameters (LCEA, acetabular index (AI°), alpha angle (α°), femoral version, acetabular version). Indirect signs of instability consisting of the femoro-epiphyseal acetabular roof index (FEAR), iliocapsularis-to-rectus-femoris (IC/RF) ratio and labral dimensions (height-to-length ratio) were assessed in both groups. Partial Pearson correlation, logistic multiple regression analysis and Receiver-Operating Characteristic (ROC) curve analysis were performed to determine correlations, as well as the sensitivity and specificity of these signs to differentiate between healthy hips and BHD. RESULTS On binary logistic multiple regression analysis, the FEAR Index was the only independent predictor to differentiate between BHD and healthy hips (p < 0.001). The IC/RF ratio did not achieve significance. The calculated area under the curve (AUC) was 0.93 (0.87 - 0.99, CI 95%, p < 0.001) for the FEAR Index and 0.81 (0.70 - 0.92, CI 95%, p < 0.001) for the height-length ratio. Using the predefined cut-off values (dysplastic-FEAR Index ≥ 5° or labral height-to-length ratio ≤ 0.5), 27% sensitivity/100% specificity and 20% sensitivity/ 100% specificity, were achieved. ROC analysis provided the following new thresholds: FEAR Index ≥ -5° (73% sensitivity/97% specificity); labral height-to-length ratio ≤ 0.8 (70% sensitivity, 79% specificity). CONCLUSION In our cohort, the FEAR index was an independent parameter that could differentiate between borderline dysplastic and asymptomatic hips. The previously published values for both the FEAR index and labral hypertrophy ratio had a poor sensitivity in differentiating symptomatic unstable BHD from healthy hips. The cut-off values of ≥ -5° (FEAR index) and ≤ 0.8 (labral height-to-length ratio) provided acceptable sensitivity and specificity when comparing to morphological healthy hips.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland.
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
| | - Florian B Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Johannes Scherr
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, 8008, Zurich, Switzerland
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Kaiser D, Hoch A, Dimitriou D, Groeber T, Bomberg H, Aguirre JA, Eichenberger U, Zingg PO. Perioperative Intravenous Dexamethasone Significantly Reduces Postoperative Opioid Requirement and Nausea After Unilateral Elective Hip Arthroscopy: A Randomized Double-blinded Placebo-controlled Trial. Am J Sports Med 2024; 52:1165-1172. [PMID: 38456291 PMCID: PMC10986151 DOI: 10.1177/03635465241232157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/20/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Previous studies have shown that dexamethasone has a positive effect on postoperative pain control, opioid consumption, nausea, and vomiting and length of hospital stay after arthroplasty surgery. PURPOSE/HYPOTHESIS The purpose of this study was to assess whether adding perioperative dexamethasone to our current pain regimen after hip arthroscopy is more effective than a placebo. It was hypothesized that dexamethasone would reduce postoperative pain, reduce opioid consumption, improve subjective pain and nausea scores, and reduce the number of vomiting events. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 50 patients requiring unilateral elective hip arthroscopy were randomized to receive intravenous dexamethasone immediately before induction of anesthesia and at 8 am on the first postoperative day (2 ×12 mg) or a placebo (sodium chloride 0.9%). The patient, the surgeons, the treating anesthesiologist, and the involved nursing and physical therapy personnel were blinded to group assignment. The primary outcome was postoperative pain, and secondary outcomes were opioid consumption and nausea scores-assessed using a translated revised version of the American Pain Society Patient Outcome Questionnaire 6 hours postoperatively and on days 1 and 2-and vomiting events. A clinical follow-up was performed 12 weeks postoperatively to assess adverse events. RESULTS The mean age at inclusion was 29 years in both groups. Postoperative pain levels did not differ significantly in most instances. Opioid requirements during the hospitalization in the dexamethasone group were significantly lower than those in the placebo group (31.96 ± 20.56 mg vs 51.43 ± 38 mg; P = .014). Significantly fewer vomiting events were noted in the dexamethasone group (0.15 ± 0.59 vs 0.65 ± 0.91; P = .034). Descriptive data and surgical parameters did not differ significantly. CONCLUSION Perioperative intravenous dexamethasone significantly reduced postoperative opioid consumption by 40% without compromising pain level and safety, as no corticosteroid-related side effects were observed. Dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy. REGISTRATION NCT04610398 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Tanja Groeber
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Hagen Bomberg
- Department of Anaesthesiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - José A. Aguirre
- Department of Anaesthesiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Urs Eichenberger
- Department of Anaesthesiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Andronic O, Chaharbakhshi EO, Zingg PO, Germann C, Rahm S, Lall AC, Domb BG. No Difference in Patient-Reported Outcomes for Periacetabular Osteotomy and Hip Arthroscopy With Capsular Plication in the Setting of Borderline Hip Dysplasia: A Propensity-Matched Multicenter Study With Minimum 5-Year Follow-Up. Arthroscopy 2024; 40:754-762. [PMID: 37422025 DOI: 10.1016/j.arthro.2023.06.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/22/2023] [Accepted: 06/22/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To compare minimum 5-year patient-reported outcome measures after hip arthroscopy (HA) and periacetabular osteotomy (PAO) for borderline hip dysplasia. METHODS Hips with a lateral center-edge angle (LCEA) between 18° and less than 25° that underwent either PAO or HA were selected from 2 institutions. The exclusion criteria were as follows: LCEA less than 18°, Tönnis osteoarthritis grade greater than 1, prior hip surgical procedures, active inflammatory disease, Workers' Compensation, and concomitant surgery. Patients underwent propensity matching based on age, sex, body mass index, and Tönnis osteoarthritis grade. Patient-reported outcome measures included the modified Harris Hip Score, as well as calculation of the minimal clinically important difference, patient acceptable symptom state, and maximum outcome improvement satisfaction threshold. Preoperative radiographic predictors included comparison of the Femoro-epiphyseal Acetabular Roof index and ligamentum teres lesions. RESULTS A total of 28 PAO patients underwent propensity matching to 49 HA patients. The 2 groups were similar in terms of mean age, sex, preoperative body mass index, and LCEA. The PAO group had a longer mean follow-up period (95.8 months vs 81.3 months, P = .001). The mean Femoro-epiphyseal Acetabular Roof index was significantly lower preoperatively in the HA group (P < .001). The 2 groups showed similar and significant improvements in the mean modified Harris Hip Score from preoperatively to latest follow-up (P < .001). The relative risk of subsequent surgery in the PAO group was 3.49 (P = .024), mostly attributed to hardware removal (25%). The revision rate was 3.6% in the PAO group and 8.2% in the HA group (P = .65). One patient in the PAO group required revision HA for intra-articular adhesions. Three of the patients requiring revision in the HA group underwent PAO because of persistent pain, and one underwent revision HA alone. Conversion to total hip arthroplasty was required in 1 patient in the HA group and no patients in the PAO group. CONCLUSIONS Both PAO and HA with capsular plication provide borderline hip dysplasia patients with clinically significant improvements and low revision rates at a minimum of 5 years postoperatively. LEVEL OF EVIDENCE Level III, retrospective, comparative therapeutic trial.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | | | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ajay C Lall
- LALL Orthopedics Research Academy, Paramus, New Jersey, U.S.A
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, U.S.A
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Hoch A, Liebmann F, Farshad M, Fürnstahl P, Rahm S, Zingg PO. Augmented reality-guided pelvic osteotomy of Ganz: feasibility in cadavers. Arch Orthop Trauma Surg 2024; 144:1077-1089. [PMID: 38133802 PMCID: PMC10896923 DOI: 10.1007/s00402-023-05167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/25/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION The periacetabular osteotomy is a technically demanding procedure with the goal to improve the osseous containment of the femoral head. The options for controlled execution of the osteotomies and verification of the acetabular reorientation are limited. With the assistance of augmented reality, new possibilities are emerging to guide this intervention. However, the scientific knowledge regarding AR navigation for PAO is sparse. METHODS In this cadaveric study, we wanted to find out, if the execution of this complex procedure is feasible with AR guidance, quantify the accuracy of the execution of the three-dimensional plan, and find out what has to be done to proceed to real surgery. Therefore, an AR guidance for the PAO was developed and applied on 14 human hip cadavers. The guidance included performance of the four osteotomies and reorientation of the acetabular fragment. The osteotomy starting points, the orientation of the osteotomy planes, as well as the reorientation of the acetabular fragment were compared to the 3D planning. RESULTS The mean 3D distance between planned and performed starting points was between 9 and 17 mm. The mean angle between planned and performed osteotomies was between 6° and 7°. The mean reorientation error between the planned and performed rotation of the acetabular fragment was between 2° and 11°. CONCLUSION The planned correction can be achieved with promising accuracy and without serious errors. Further steps for a translation from the cadaver to the patient have been identified and must be addressed in future work.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Florentin Liebmann
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Kaiser D, Hoch A, Sutter R, Zingg PO. Gluteus maximus tendon transfer as a salvage option for painful chronic hip abductor insufficiency: clinical and MRI results with a minimum follow-up of 24 months. Hip Int 2024; 34:240-247. [PMID: 37670460 PMCID: PMC10935620 DOI: 10.1177/11207000231197760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/09/2023] [Indexed: 09/07/2023]
Abstract
INTRODUCTION Chronic hip abductor insufficiency is a rare debilitating condition. In cases refractory to conservative treatment and not amenable to direct repair an augmentation becomes necessary. The preferred salvage method at our institution is augmentation with the anterior third of the gluteus maximus tendon. The aim of this study is to describe the results of 8 patients, treated for painful chronic hip abductor insufficiency with gluteus maximus muscle transfer, after a minimal follow-up of 24 months including a full clinical and MRI evaluation of the hip abductors pre- and postoperatively. METHODS We retrospectively reviewed a consecutive series of 8 patients who were surgically managed for painful chronic hip abductor insufficiency. All patients had a Trendelenburg sign, impaired muscle strength (M ⩽ 3) as well as a complete avulsion of the hip abductors with marked fatty degeneration (⩾3). Pain levels, muscle strength, functional scores as well as a postoperative MRI was obtained after a minimal follow-up of 24 months. RESULTS The mean age of the patients was 69 years, mean follow-up was 35 (26-54) months. Pain was significantly reduced postoperatively to VAS 2.5 from VAS 5 (p = 0.046). Trendelenburg sign remained positive in all patients and hip abductor strength did not improve significantly from 2.4 to 3.1 (p = 0.19). Complete healing of the transferred tendon was confirmed by MRI in all patients at last follow-up. CONCLUSIONS In the setting of painful chronic hip abductor insufficiency refractory to conservative treatment with advanced muscle degeneration without the possibility of a direct reconstruction the gluteus maximus tendon transfer significantly decreased pain. The effect on hip abductor strength and patient-reported functional outcome scores is limited. Despite the modest results it remains our preferred salvage treatment option for lack of better alternatives. Larger studies are necessary to confirm these findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Meisterhans M, Dimitriou D, Fasser MR, Hoch A, Jud L, Zingg PO. Influence of offset on osseointegration in cementless total hip arthroplasty: A finite element study. J Orthop Res 2024. [PMID: 38376065 DOI: 10.1002/jor.25808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024]
Abstract
Early aseptic loosening is caused by deficient osteointegration of the femoral stem due to increased micromotions and represents a common mode of failure in uncemented total hip arthroplasty (THA). This study hypothesized that a higher femoral offset, a smaller stem size and obesity increase femoral micromotion, potentially resulting in early aseptic loosening. A finite element analysis was conducted based on computed tomography segmented model of four patients who received a THA with a triple-tapered straight stem (Size 1, 3, 6). The influence of femoral stem offset (short neck, standard, lateral), head length (S to XXL), femoral anteversion and obesity during daily activities of fast walking and stair climbing was analyzed. The micromotions for the femoral stem zones were compared to a threshold representing a value above which only partial osseointegration is expected. The minimum femoral offset configuration compared to the maximum offset configuration (short neck stem, S head vs. lateral stem, XXL head) leads to a relative mean micromotion increase of 24% for the upper stem zone. Increasing the body weight (body mass index 30-35 kg/m2 ) increases the micromotion by 20% for all stem zones. The obese population recorded threshold-exceeding micromotions for stem sizes 1 and 3 for all offset configurations during stair climbing. Higher femoral offset, a smaller stem size, and higher loading due to obesity lead to an increase in micromotion between the prosthesis and proximal femur and represent a risk configuration for impaired osseointegration of a triple-tapered straight stem, especially when these three factors are present simultaneously.
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Affiliation(s)
- Michel Meisterhans
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Dimitriou D, Meisterhans M, Geissmann M, Borpas P, Hoch A, Rosner J, Schubert M, Aguirre J, Eichenberger U, Zingg PO. The effect of experimentally induced gluteal muscle weakness on joint kinematics, reaction forces, and dynamic balance performance during deep bilateral squats. J Orthop Res 2024; 42:164-171. [PMID: 37309814 DOI: 10.1002/jor.25644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
Squatting is a common daily activity and fundamental exercise in resistance training and closed kinetic chain programs. The aim of this study was to investigate the effects of an experimentally induced weakness of the gluteal muscles on joint kinematics, reactions forces (JRFs), and dynamic balance performance during deep bilateral squats in healthy young adults. Ten healthy adults received sequential blocks of (1) branch of the superior gluteal nerve to the tensor fasciae latae (SGNtfl) muscle, (2) superior gluteal nerve (SGN), and (3) inferior gluteal nerve (IGN) on the dominant right leg. At the control condition and following each block, the participants were instructed to perform deep bilateral squats standing on two force plates. Hip, knee, ankle, and pelvis kinematics did not differ significantly following iatrogenic weakness of gluteal muscles. The most important finding was the significant differences in JRFs following SGN and IGN block, with the affected hip, patellofemoral, and ankle joint demonstrating lower JRFs, whereas the contralateral joints demonstrated significantly higher JRFs, especially the patellofemoral joint which demonstrated an average maximum difference of 1.43 x body weight compared with the control condition. When performing a deep bilateral leg squat under SGN and IGN block, the subjects demonstrated an increased center of pressure (CoP) range and standard deviation (SD) in mediolateral compared with the control condition. These results imply that squat performance changes significantly following weakness of gluteal muscles and should be considered when assessing and training athletes or patients with these injuries.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Michel Meisterhans
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Marina Geissmann
- Swiss Center for Movement Analysis, Balgrist Campus AG, Zurich, Switzerland
| | - Paul Borpas
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Jan Rosner
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Martin Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - José Aguirre
- Balgrist University Hospital, Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Urs Eichenberger
- Balgrist University Hospital, Department of Anesthesiology, Intensive Care and Pain Medicine, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
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Dimitriou D, Zindel C, Winkler E, Cornaz F, Mazel P, Zingg PO. Combined Anteversion Threshold to Avoid Anterior Dislocation in Primary Total Hip Arthroplasty Performed Through the Direct Anterior Approach. J Arthroplasty 2024; 39:145-150. [PMID: 37331442 DOI: 10.1016/j.arth.2023.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Component malposition in total hip arthroplasty (THA) can lead to dislocation, early implant failure, and revision surgery. As the surgical approach might affect the targeted combined anteversion (CA) of THA components, the present study aimed to evaluate the optimal CA threshold to avoid anterior dislocation in primary THA performed through a direct anterior approach (DAA). METHODS A total of 1,176 THAs in 1,147 consecutive patients (men: 593, women: 554) who had an average age of 63 years (range, 24 to 91) and a mean body mass index of 29 (range, 15 to 48) were identified. Medical records were reviewed for dislocation, whereas postoperative radiographs were assessed to measure the acetabular inclination and CA using a previously validated radiographic method. RESULTS An anterior dislocation occurred in 19 patients at an average of 40 days postoperatively. The average CA in patients who did and did not have a dislocation was 66 ± 8° and 45 ± 11°, respectively (P < .001). In 5 of 19 of the patients, a THA was performed for secondary osteoarthritis and 17 of 19 had a 28-mm femoral head. A CA ≥ 60° yielded a sensitivity of 93% and specificity of 90% for predicting an anterior dislocation in the present cohort. A CA ≥ 60° was associated with a significantly higher risk of anterior dislocation (odds ratio = 75.6; P < .001) compared to patients who had a CA<60 points. CONCLUSION The optimal CA to avoid anterior dislocations in THA performed through the DAA should be less than 60°. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Christoph Zindel
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Peter Mazel
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
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Marth AA, Ofner C, Zingg PO, Sutter R. Quantifying cup overhang after total hip arthroplasty: standardized measurement using reformatted computed tomography and association of overhang distance with iliopsoas impingement. Eur Radiol 2023:10.1007/s00330-023-10479-5. [PMID: 38147169 DOI: 10.1007/s00330-023-10479-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/20/2023] [Accepted: 10/24/2023] [Indexed: 12/27/2023]
Abstract
OBJECTIVES Currently, there is no standardized measurement method for evaluating cup overhang (CO) in patients undergoing total hip arthroplasty (THA). We propose a novel, standardized method of measuring overhang distance in patients following primary total hip arthroplasty (THA) on computed tomography (CT) images after multiplanar reformation and compare it to a previously proposed measurement method on sagittal CT images. MATERIALS AND METHODS This retrospective study included patients who underwent primary THA with an anterior approach. Patients with cup overhang (CO) and iliopsoas impingement (IPI) were identified by clinical and imaging data. Uncorrected overhang distance (ODu) was evaluated on orthogonal sagittal CT images while corrected overhang distance (ODc) was evaluated on reformatted sagittal CT images corrected for pelvic rotation and aligned with the plane of the cup face. RESULTS Out of 220 patients with THA, 23 patients (10.4%) with CO and 16 patients (7.3%) with IPI were identified. CO was significantly associated to IPI (p < 0.001). The inter- and intrareader agreement was almost perfect for ODc (κ = 0.822, κ = 0.850), whereas it was fair and moderate for ODu (κ = 0.391, κ = 0.455), respectively. The discriminative ability of ODc was excellent (area under the curve (AUC) = 0.909 (95% confidence interval (CI) 0.784-1.000)) in the receiver operating characteristic analysis. Conversely, AUC for ODu was poor, measuring 0.677 (95% CI 0.433-0.921). CONCLUSION We implemented a novel measurement method for CT images reformatted at the plane of the cup face to assess overhang distance in patients with CO following THA. CLINICAL RELEVANCE STATEMENT While further validation is necessary, the proposed method is characterized by its high reproducibility and might be used to predict the occurrence of iliopsoas impingement in patients with cup overhang following total hip arthroplasty. KEY POINTS • A novel, standardized method of measuring cup overhang distance in patients following primary total hip arthroplasty on CT images is proposed. • Cup overhang was associated to iliopsoas impingement. The proposed method was reproducible and showed excellent prediction of iliopsoas impingement in patients with cup overhang. • This method can be implemented in clinical practice when assessing CT images of patients with cup overhang for iliopsoas impingement.
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Affiliation(s)
- Adrian A Marth
- Swiss Center for Musculoskeletal Imaging, Balgrist Campus AG, Zurich, Switzerland.
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christian Ofner
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, Faculty of Medicine, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Jud L, Neopoulos G, Dimitriou D, Zingg PO. Femoro-Epiphyseal Acetabular Roof (FEAR) Index Values on Anteroposterior Pelvic Radiographs Significantly Increase With Hip Adduction and Decrease With Abduction. Arthroscopy 2023:S0749-8063(23)01017-4. [PMID: 38151166 DOI: 10.1016/j.arthro.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/29/2023]
Abstract
PURPOSE To investigate the impact of hip adduction and abduction on the femoro-epiphyseal acetabular roof (FEAR) index using conventional anteroposterior pelvic radiographs of patients with borderline hip dysplasia (BHD). METHODS Patients with BHD (lateral center edge angle [LCEA] with values of 18° ≤ LCEA <25°) and who were subject to periacetabular osteotoym were selected from a consecutive retrospective cohort from January 2009 to January 2016. The hip ad-/abduction (adduction handled as negative values) and the FEAR index (lateral opening angles handled as positive values) were measured in the initially standardized acquired pelvic radiographs. Thereafter, using surgical planning software, different degrees of hip adduction and abduction were simulated from 20° of adduction to 30° of abduction, and the FEAR index was measured at each position. Pearson correlation was used to identify a potential correlation between the hip ad-/abduction and the FEAR index. RESULTS Eighty-nine hips were included. Initial radiographs showed unintentional mean ad-/abduction of -5.3° ± 3.1° (range, -14° to 2°). The mean FEAR index at the initial ad-/abduction angle was -3.6° ± 7.2° (range, -18.0° to 16.0°) and was significantly different from neutral position (0° of ad-/abduction) -9.2° ± 7.0° (range, -27.0° to 10.0°) (P < .001). The FEAR index was negatively correlated to the hip ad-/abduction angle (r = 1, P < .001), with lower values for the FEAR index with the hip in abduction. CONCLUSIONS Significant differences in FEAR index measurements were observed depending on hip ad-/abduction on pelvic radiographs. A linear change of the FEAR index of 5° per 5° of hip adduction or abduction could be demonstrated, with adduction resulting in increasing and abduction in decreasing values for the FEAR index. LEVEL OF EVIDENCE Level III, diagnostic study.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland.
| | - Georgios Neopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zürich, Switzerland
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Hodel S, Flury A, Hoch A, Zingg PO, Vlachopoulos L, Fucentese SF. The relationship between pelvic tilt, frontal, and axial leg alignment in healthy subjects. J Orthop Sci 2023; 28:1353-1358. [PMID: 36336637 DOI: 10.1016/j.jos.2022.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/25/2022] [Accepted: 10/09/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The relationship between anterior pelvic tilt and overall sagittal alignment has been well-described previously. However, the relationship between pelvic tilt, frontal, and axial leg alignment remains unclear. The aim of the study was to analyze the relationship between pelvic tilt and frontal and axial leg alignment in healthy subjects. MATERIAL AND METHODS Thirty healthy subjects (60 legs) without prior surgery underwent standing biplanar long leg radiograph. Pelvic parameters (pelvic tilt, pelvic incidence, sacral slope), hip-knee-ankle angle (HKA), femoral antetorsion and tibial torsion were measured using SterEOS (EOS Imaging) software. EOS was acquired with the feet directing straight anteriorly, which corresponds to a neutral foot progression angle (FPA). The influence of HKA, femoral antetorsion, tibial torsion and gender on pelvic tilt was analyzed in a univariate correlation and multiple regression model. RESULTS Sixteen female subjects and 14 male subjects with a mean age of 27.1 years ± 10 (range 20-67) were included. HKA, femoral antetorsion, and tibial torsion correlated with anterior pelvic tilt in univariate analysis (all p < 0.05). Anterior pelvic tilt increased 1.1° (95% CI: 0.7 to 1.5) per 1° of knee valgus (p < 0.001) and 0.5° (95% CI: 0.3 to 0.7) per 1° of external tibial torsion (p < 0.001). Overall, linear regression model fit explained 39% of variance in pelvic tilt by the HKA, femoral antetorsion and tibial torsion (R2 = 0.385; p < 0.001). CONCLUSION Valgus alignment and increasing tibial torsion demonstrated a weak correlation with an increase in anterior pelvic tilt in healthy subjects when placing their feet anteriorly. The relationship between frontal, axial leg alignment and pelvic tilt needs to be considered in patients with multiple joint disorders at the hip, knee and spine. Alteration of the frontal, or rotational profile after realignment surgery or by implant positioning might influence the pelvic tilt when the FPA is kept constant.
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Affiliation(s)
- Sandro Hodel
- Balgrist University Hospital, University of Zurich, Department of Orthopedics, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Andreas Flury
- Balgrist University Hospital, University of Zurich, Department of Orthopedics, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Armando Hoch
- Balgrist University Hospital, University of Zurich, Department of Orthopedics, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Patrick O Zingg
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zürich, Switzerland.
| | - Lazaros Vlachopoulos
- Balgrist University Hospital, University of Zurich, Department of Orthopedics, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Sandro F Fucentese
- Balgrist University Hospital, University of Zurich, Department of Orthopedics, Forchstrasse 340, 8008 Zurich, Switzerland.
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13
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Niehaus R, Zingg PO, Hoch A, Luttenberger M, Stefan R. Hip arthroscopy versus total hip arthroplasty-A study on patients with obesity above 40 years of age. Clin Obes 2023; 13:e12590. [PMID: 36919471 DOI: 10.1111/cob.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Patients older than 40 years with a body-mass-index (BMI) >30 kg/m2 , a femoroacetabular-impingement (FAI) and little cartilage damage are a challenge for hip surgeons. Hip-arthroscopy (HAS) or conservative therapy until a total hip arthroplasty (THA) is needed are possible treatments. Our research purpose was to compare the clinical results and complication/reoperation rate after HAS and THA in patients with obesity over 40 years. This retrospective study includes a consecutive series of patients with obesity (BMI >30 kg/m2 ) who underwent HAS (19 hips) and THA (37 hips) over 40 years of age between 2007 and 2013 at our institution with a minimum of 12-months follow-up. Outcome measures were WOMAC (Western Ontario und McMaster Universities Arthritis Index), subjective-hip-value (SHV), residual complaints and the reoperation rate. Patient data and scores were collected pre-operative, 12 months post-operatively and at the last follow-up. Both groups showed a comparable age (mean 48 years). Regarding SHV-Scores the THA-group shows continuous significant improvements. Reaching 87% (range 50%-100%), the HAS-group showed in case of the SHV no significant change after 1 year and an improvement from preoperative to the last follow-up reaching 72% (range 30%-100%) at the last follow-up. Residual groin pain was significant higher in the HAS-group. Two deep infections (5.4%) requiring reoperations were reported in the THA-group. The conversion rate to THA after a mean time of 60 months was 26% (5 of 19). Patients with obesity over 40 years demonstrated inferior SHV, more often residual pain and revision surgery after HAS, when compared to THA at short-term, with conversions rate of one fourth. However, THA in this patient group showed high infection rate of 5%. This information is relevant for counselling above-mentioned patients.
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Affiliation(s)
- Richard Niehaus
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Armando Hoch
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Martin Luttenberger
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Rahm Stefan
- Department of Orthopedics, University Hospital Balgrist, University of Zürich, Zürich, Switzerland
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Dimitriou D, Zindel C, Winkler E, Cornaz F, Mazel P, Zingg PO. A novel method for evaluating combined component anteversion in total hip arthroplasty on cross-table lateral hip radiographs. Arch Orthop Trauma Surg 2023; 143:5977-5984. [PMID: 36899142 PMCID: PMC10449991 DOI: 10.1007/s00402-023-04825-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Accurate measurement of combined component anteversion (CA) is important in evaluating the radiographic outcomes following total hip arthroplasty (THA). The aim of the present study was to evaluate the accuracy and reliability of a novel radiographic method in estimating CA in THA. MATERIALS AND METHODS The radiographs and computer tomography of patients who underwent a primary THA were retrospectively reviewed, to measure the radiographic CA (CAr), defined as the angle between a line connecting the center of the femoral head to the most anterior rim of the acetabular cup and a line connecting the center of the femoral head to the base of the femoral head to allow a comparison with the CA measured on the CT (CACT). Subsequently, a computational simulation was performed to evaluate the effect of cup anteversion, inclination, stem anteversion, and leg rotation on the CAr and develop a formula that would correct the CAr according to the acetabular cup inclination based on the best-fit equation. RESULTS In the retrospective analysis of 154 THA, the average CAr_cor, and CACT were 53 ± 11° and 54 ± 11° (p > 0.05), respectively. A strong correlation was found between CAr and CACT (r = 0.96, p < 0.001), with an average bias of - 0.5° between CAr_cor and CACT. In the computational simulation, the CAr was strongly affected by the cup anteversion, inclination, stem anteversion, and leg rotation. The formula to convert the CAr to CA_cor was: CA-cor = 1.3*Car - (17* In (Cup Inclination) - 31. CONCLUSION The combined anteversion measurement of THA components on the lateral hip radiograph is accurate and reliable, implying that it could be routinely used postoperatively but also in patients with persistent complaints following a THA. LEVEL OF EVIDENCE Cross-sectional study, Level III.
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Affiliation(s)
- Dimitris Dimitriou
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Christoph Zindel
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Elin Winkler
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Peter Mazel
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008, Zurich, Switzerland
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Hoch A, Grossenbacher G, Jungwirth-Weinberger A, Götschi T, Fürnstahl P, Zingg PO. The periacetabular osteotomy: angulation of the supraacetabular osteotomy for quantification of correction. Hip Int 2023; 33:934-940. [PMID: 35672882 DOI: 10.1177/11207000221103079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Malcorrection of the acetabular fragment in periacetabular osteotomy (PAO) is associated with inferior outcomes. 2-dimensional radiographic parameters are being used for intraoperative verification of a satisfactory result. After reorientation of the fragment, the acetabular version must be verified with an intraoperative radiograph. In the case of an unsatisfactory correction, a reorientation would be required. A slim and radiation-free intraoperative navigation method to directly quantify the correction is highly desirable. AIM To find out whether the measurable angulation of the supraacetabular osteotomy can be used for this purpose. METHODS To determine the angulation, 13 consecutive patients who underwent a PAO were investigated. The preoperative and postoperative standard radiographs as well as CT scans were available. The surgically produced alteration of radiographic parameters was correlated to tilting and spreading of the supraacetabular osteotomy planes. RESULTS Tilting of the supraacetabular osteotomy planes correlates strongly to alteration of the lateral centre-edge angle (LCEA) and the acetabular index (ACI), whereas spreading of the same planes showed also a strong correlation, but to the LCEA only. 1° of tilting resulted in a 0.2° alteration of the LCEA and a 0.5° alteration of the ACI, whereas 1° of spreading resulted in a 0.5° alteration of the LCEA. CONCLUSIONS This study shows that the measurable angulation of the supraacetabular osteotomy planes can be used to monitor the three-dimensional reorientation of the acetabular fragment in PAO. As long as sophisticated modalities are lacking, this technique offers an easy way to intraoperatively navigate the correction in PAO.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
| | | | | | - Tobias Götschi
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science, Balgrist University Hospital, University of Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Switzerland
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Hasler J, Flury A, Hoch A, Cornaz F, Zingg PO, Rahm S. Total hip arthroplasty through the direct anterior approach for sequelae of Legg-Calvé-Perthes disease. Arch Orthop Trauma Surg 2023; 143:5935-5944. [PMID: 36806985 PMCID: PMC10449662 DOI: 10.1007/s00402-023-04791-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/22/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Due to multiplanar deformities of the hip, total hip arthroplasty (THA) for sequelae of Legg-Calvé-Perthes disease (LCPD) is often technically demanding. This study aimed to compare the clinical and radiographic outcomes of patients with sequelae of LCPD undergoing THA through the direct anterior approach (DAA) and non-anterior approaches to the hip. METHODS All patients with sequelae of LCPD who underwent primary THA between 2004 and 2018 (minimum follow-up: 2 years) were evaluated and separated into two groups: THA through the DAA (Group AA), or THA through non-anterior approaches to the hip (Group non-AA). Furthermore, a consecutive control group of patients undergoing unilateral THA through the DAA for primary hip osteoarthritis (Group CC) was retrospectively reviewed for comparison. RESULTS Group AA comprises 14 hips, group non-AA 17 hips and group CC 30 hips. Mean follow-up was 8.6 (± 5.2; 2-15), 9.0 (± 4.6; 3-17) and 8.1 (± 2.2; 5-12) years, respectively. At latest follow-up, Harris Hip Score was 90 (± 20; 26-100), 84 (± 15; 57-100), and 95 (± 9; 63-100) points, respectively. Overall, 6 patients treated for LCPD (each 3 patient in the AA and non-AA group) developed postoperative sciatic nerve palsy, of which only one was permanent. Complication-related revision rate at the latest follow-up was 15% in the AA-group and 25% in the non-AA group, respectively. CONCLUSION THA through the DAA might be a credible option for the treatment of sequelae of LCPD with comparable complication rates and functional outcomes to non-anterior approaches.
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Affiliation(s)
- Julian Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Frédéric Cornaz
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Kaiser D, Hoch A, Rahm S, Stern C, Sutter R, Zingg PO. Combining the advantages of 3-D and 2-D templating of total hip arthroplasty using a new tin-filtered ultra-low-dose CT of the hip with comparable radiation dose to conventional radiographs. Arch Orthop Trauma Surg 2023; 143:5345-5352. [PMID: 36460762 PMCID: PMC10374735 DOI: 10.1007/s00402-022-04697-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/08/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Inaccurately scaled radiographs for total hip arthroplasty (THA) templating are a source of error not recognizable to the surgeon and may lead to inaccurate reconstruction and thus revision surgery or litigation. Planning based on computed tomography (CT) scans is more accurate but associated with higher radiation exposure. The aim of this study was (1) to retrospectively assess the scaling deviation of pelvic radiographs; (2) to prospectively assess the feasibility and the radiation dose of THA templating on radiograph-like images reconstructed from a tin-filtered ultra-low-dose CT dataset. METHODS 120 consecutive patients were retrospectively analyzed to assess the magnification error of our current THA templates. 27 consecutive patients were prospectively enrolled and a radiographic work-up in the supine position including a new tin-filtered ultra-low-dose CT scan protocol was obtained. THA was templated on both images. Radiation dose was calculated. RESULTS Scaling deviations between preoperative radiographs and CT of ≥ 5% were seen in 25% of the 120 retrospectively analyzed patients. Between the two templates trochanter tip distance differed significantly (Δ2.4 mm, 0-7 mm, p = 0.035)), predicted femoral shaft size/cup size was the same in 45%/41%. The radiation dose of the CT (0.58 mSv, range 0.53-0.64) was remarkably low. CONCLUSION Scaling deviations of pelvic radiographs for templating THA may lead to planning errors of ≥ 3 mm in 25% and ≥ 6 mm in 2% of the patients. 2-D templating on radiograph-like images based on tin-filtered ultra-low-dose CT eliminates this source of error without increased radiation dose. LEVEL OF EVIDENCE Retrospective and prospective comparative study, Level III.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Andronic O, Germann C, Jud L, Zingg PO. Factors influencing patient-reported outcomes following periacetabular osteotomy and open osteochondroplasty in the setting of borderline hip dysplasia. Bone Joint J 2023; 105-B:735-742. [PMID: 37391200 DOI: 10.1302/0301-620x.105b7.bjj-2022-1058.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Aims This study reports mid-term outcomes after periacetabular osteotomy (PAO) exclusively in a borderline hip dysplasia (BHD) population to provide a contrast to published outcomes for arthroscopic surgery of the hip in BHD. Methods We identified 42 hips in 40 patients treated between January 2009 and January 2016 with BHD defined as a lateral centre-edge angle (LCEA) of ≥ 18° but < 25°. A minimum five-year follow-up was available. Patient-reported outcomes (PROMs) including Tegner score, subjective hip value (SHV), modified Harris Hip Score (mHHS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were assessed. The following morphological parameters were evaluated: LCEA, acetabular index (AI), α angle, Tönnis staging, acetabular retroversion, femoral version, femoroepiphyseal acetabular roof index (FEAR), iliocapsularis to rectus femoris ratio (IC/RF), and labral and ligamentum teres (LT) pathology. Results The mean follow-up was 96 months (67 to 139). The SHV, mHHS, WOMAC, and Tegner scores significantly improved (p < 0.001) at last follow-up. According to SHV and mHHS, there were three hips (7%) with poor results (SHV < 70), three (7%) with a fair score (70 to 79), eight (19%) with good results (80 to 89), and 28 (67%) who scored excellent (> 90) at the last follow-up. There were 11 subsequent operations: nine implant removals due to local irritation, one resection of postoperative heterotopic ossification, and one hip arthroscopy for intra-articular adhesions. No hips were converted to total hip arthroplasty at last follow-up. The presence of preoperative labral lesions or LT lesions did not influence any PROMs at last follow-up. From the three hips that had poor PROMs, two have developed severe osteoarthritis (> Tönnis II), presumably due to surgical overcorrection (postoperative AI < -10°). Conclusion PAO is reliable in treating BHD with favourable mid-term outcomes. Concomitant LT and labral lesions did not negatively influence outcomes in our cohort. Technical accuracy with avoidance of overcorrection is essential in achieving successful outcomes.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Christoph Germann
- Department of Radiology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
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Flury A, Hoch A, Hodel S, Imhoff FB, Fucentese SF, Zingg PO. No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:414-423. [PMID: 35031820 DOI: 10.1007/s00167-021-06843-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/03/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to investigate if one level of corrective femoral osteotomy (subtrochanteric or supracondylar) bears an increased risk of unintentional implications on frontal and sagittal plane alignment in a simulated clinical setting. METHODS Out of 100 cadaveric femora, 23 three-dimensional (3-D) surface models with femoral antetorsion (femAT) deformities (> 22° or < 2°) were investigated, and femAT normalized to 12° with single plane rotational osteotomies, perpendicular to the mechanical axis of the femur. Change of the frontal and sagittal plane alignment was expressed by the mechanical lateral distal femoral angle (mLDFA) and the posterior distal femoral angle (PDFA), respectively. The influence of morphologic factors of the femur [centrum-collum-diaphyseal (CCD) angle and antecurvatum radius (ACR)] were assessed. Furthermore, position changes of the lesser (LT) and greater trochanters (GT) in the frontal and sagittal plane compared to the hip centre were investigated. RESULTS Mean femoral derotation of the high-antetorsion group (n = 6) was 12.3° (range 10-17°). In the frontal plane, mLDFA changed a mean of 0.1° (- 0.06 to 0.3°) (n.s.) and - 0.3° (- 0.5 to - 0.1) (p = 0.03) after subtrochanteric and supracondylar osteotomy, respectively. In the sagittal plane, PDFA changed a mean of 1° (0.7 to 1.1) (p = 0.03) and 0.3° (0.1 to 0.7) (p = 0.03), respectively. The low-antetorsion group (n = 17) was rotated by a mean of 13.8° (10°-23°). mLDFA changed a mean of - 0.2° (- 0.5° to 0.2°) (p < 0.006) and 0.2° (0-0.5°) (p < 0.001) after subtrochanteric and supracondylar osteotomy, respectively. PDFA changed a mean of 1° (- 2.3 to 1.3) (p < 0.01) and 0.5° (- 1.9 to 0.3) (p < 0.01), respectively. The amount of femAT correction was associated with increased postoperative deviation of the mechanical leg axis (p < 0.01). Using multiple regression analysis, no other morphological factors were found to influence mLDFA or PDFA. Internal rotational osteotomies decreased the ischial-lesser trochanteric space by < 5 mm in both the frontal and sagittal plane (p < 0.001). CONCLUSIONS In case of femAT correction of ≤ 20°, neither subtrochanteric nor supracondylar femoral derotational or rotational osteotomies have a clinically relevant impact on frontal or sagittal leg alignment. A relevant deviation in the sagittal (but not frontal plane) might occur in case of a > 25° subtrochanteric femAT correction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Florian B Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Flury A, Hoch A, Hodel S, Imhoff FB, Fucentese SF, Zingg PO. Correction to: No relevant mechanical leg axis deviation in the frontal and sagittal planes is to be expected after subtrochanteric or supracondylar femoral rotational or derotational osteotomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:424-425. [PMID: 35147720 DOI: 10.1007/s00167-022-06905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Andreas Flury
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro Hodel
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Florian B Imhoff
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Jentzsch T, Meyer YK, Unterfrauner I, Rosskopf AB, Pfirrmann CW, Zingg PO. Can pre-operative intraarticular injection predict pain relief after total hip arthroplasty? BMC Musculoskelet Disord 2023; 24:19. [PMID: 36624434 PMCID: PMC9827715 DOI: 10.1186/s12891-022-05969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/09/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND To study if pain relief after injection and arthroplasty correlate. METHODS A retrospective cohort study included consecutive patients (n = 88; median age 64 (interquartile range (IQR) 22) years, 49 (56%) females) that received fluoroscopic-guided intra-articular hip injection with contrast agent, anaesthetic (diagnostic), and corticosteroid (therapeutic) before implantation of primary total hip arthroplasty. Pain scores were assessed pre-injection, post-injection after 15 min (diagnostic phase) at first clinical follow up (therapeutic phase; median 2 (IQR 2) months), and postoperatively (last follow up (median 15 (IQR 5) months)). Responders had reduction in pain score ≥ 20 (numeric rating scale 0-100) points. The primary outcome was the same (or inverse) response to injection and arthroplasty. RESULTS The median pain scores were higher pre-injection (68 (IQR 30) points) compared to the diagnostic phase (18 (IQR 40) points; p < 0.001), therapeutic phase (50 (IQR 40) points; p < 0.001), and post-operatively (2 (IQR 15) points; p < 0.001). On the one hand, 69 (78%) cases had the same response in the diagnostic phase and post-operatively (rho = 0.58; p < 0.001; sensitivity 83%); on the other hand 32 (36%) cases had the same response in the therapeutic phase and post-operatively (rho = 0.25; p < 0.001; sensitivity 33%). Furthermore, 57% and 91% of patients had an even better response post-operatively than in the diagnostic and therapeutic phases. CONCLUSIONS Pre-operative intraarticular injection can predict pain relief after primary total hip arthroplasty. A positive response to hip arthroplasty may be better predicted by the response to local anaesthetic (diagnostic phase) than corticosteroids. Most patients (91%) with osteoarthritis may expect better pain relief after arthroplasty compared to the therapeutic phase after injection.
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Affiliation(s)
- Thorsten Jentzsch
- grid.7400.30000 0004 1937 0650Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Yann K. Meyer
- grid.7400.30000 0004 1937 0650Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Ines Unterfrauner
- grid.7400.30000 0004 1937 0650Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Andrea B. Rosskopf
- grid.412373.00000 0004 0518 9682Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Christian W. Pfirrmann
- grid.412373.00000 0004 0518 9682Department of Radiology, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O. Zingg
- grid.7400.30000 0004 1937 0650Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Schenk P, Dimitriou D, Rahm S, Zimmermann SM, Finsterwald M, Higashigaito K, Sutter R, Zingg PO. Natural History of Degenerative Hip Abductor Tendon Lesions. Am J Sports Med 2023; 51:160-168. [PMID: 36412545 PMCID: PMC9810830 DOI: 10.1177/03635465221135759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The best treatment of degenerative hip abductor tendon lesions remains largely unknown, as the natural course of the disease has not yet been reported. The aim of the present study was to investigate the natural history of symptomatic degenerative hip abductor lesions. HYPOTHESIS Nonoperatively treated hip abductor lesions progress over time, resulting in refractory hip pain and low functional outcomes. STUDY DESIGN Case series (prognosis); Level of evidence, 4. METHODS Consecutive patients with greater trochanteric pain syndrome and degenerative changes on magnetic resonance imaging (MRI) of the symptomatic hip were included. Bilateral hip MRI scans and a clinical examination were performed at a minimum follow-up of 36 months to study the type and location of hip abductor lesion. Progression of a lesion was defined as a more severe lesion as compared with the initial MRI results or if the lesion extended to another, initially not involved, trochanteric facet. The muscle's fatty infiltration (FI) was also described. RESULTS From 106 patients identified, 58 patients (64 hips) aged 66 ± 14 years (mean ± SD) agreed to return to the clinic for follow-up MRI and met the inclusion criteria. At a mean 71-month follow-up, an overall 34% (22/64) of lesions had progressed over time: from trochanteric bursitis to tendinopathy (9/64, 14%) or partial tear (5/64, 8%), from tendinopathy to partial tear (4/64, 6%), from a partial to complete tear (3/64, 4.5%), and with 1 complete tear (1/64, 1.5%) extending to another trochanteric facet. Interestingly, 90% of partial tears remained stable or transformed into a scar. Although patients with a progressive lesion experienced more trochanteric pain (visual analog scale, 4.6 vs 2.8; P = .001), the functional outcomes were comparable with patients with a stable lesion. The majority of hips with a partial tear (64%) demonstrated a progression of gluteus minimus FI from a median grade of 1 to 2, whereas only 1 hip (3%) progressed from grade 2 to 3. Only 3 hips (9%) with a partial tear had a progression of gluteus medius FI, which did not differ significantly from the contralateral unaffected side. CONCLUSION Nonoperative treatment might be a valid long-term option for degenerative hip abductor lesions, especially for partial tears, which demonstrated a low risk of clinically relevant progression or muscle FI and similar clinical outcomes to those reported in the literature for operatively treated hip abductor tendon lesions.
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Affiliation(s)
- Pascal Schenk
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Dimitris Dimitriou
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland,Dimitris Dimitriou, MD, Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Forchstrasse 340, 8008, Zürich,
Switzerland ()
| | - Stefan Rahm
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Stefan M. Zimmermann
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Michael Finsterwald
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Kai Higashigaito
- Department of Radiology, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopedics, University
Hospital Balgrist, University of Zürich, Zürich, Switzerland
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Kaiser D, Ried E, Zingg PO, Rahm S. Acetabular reconstruction with femoral head autograft in primary total hip arthroplasty through a direct anterior approach is a reliable option for patients with secondary osteoarthritis due to developmental dysplasia of the hip. Arch Orthop Trauma Surg 2022; 142:2957-2964. [PMID: 34581861 PMCID: PMC9474438 DOI: 10.1007/s00402-021-04187-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 09/19/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Developmental dysplasia is challenging to treat with total hip arthroplasty via the direct anterior approach (DAA). Reconstructing the former anatomy while restoring the acetabular bone stock for future revisions in this young patient collective combined with the known advantages of the DAA would be desirable. The purpose of this study was to analyze the feasibility, radiographic outcome and clinical outcome of primary uncemented total hip arthroplasty with bulk femoral head autograft for acetabular augmentation through a DAA with a minimal follow-up of 12 months. METHODS A retrospective, consecutive series from March 2006 to March 2018 of 29 primary total hip arthroplasty with acetabular augmentation with bulk femoral head autograft through a direct anterior approach was identified. All complications, reoperations and failures were analyzed. Radiographic and clinical outcome was measured. RESULTS 24 patients (29 hips) with a mean age of 43 (18-75) years and a mean follow-up of 35 months (12-137) were included. Surgical indication was secondary osteoarthritis for developmental dysplasia of the hip (Hartofilakidis Grade A (n = 19), B (n = 10)) in all cases. We noted no conversion of the approach, no dislocation and no acetabular loosening. The center of rotation was significantly distalized by a mean of 9 mm (0-23) and significantly medialized by a mean of 18 mm (6-29). The bone graft was fully integrated after 12 months in all cases. CONCLUSION Acetabular reconstruction with femoral head autograft in primary THA through a direct anterior approach seems to be a reliable option for the treatment of secondary osteoarthritis in patients with DDH Hartofilakidis grade A and B. Prospective cohort studies with a large sample population and a long-term follow-up are necessary to confirm our findings.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Emanuel Ried
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
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Fischer T, Stern C, Fritz B, Zingg PO, Pfirrmann CWA, Sutter R. MRI findings of ischiofemoral impingement after total hip arthroplasty are associated with increased femoral antetorsion. Acta Radiol 2022; 63:948-957. [PMID: 34098775 DOI: 10.1177/02841851211021044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Ischiofemoral impingement (IFI) is a known complication after total hip arthroplasty (THA). PURPOSE To assess if increased postoperative (FA) is associated with magnetic resonance imaging (MRI) findings of IFI. MATERIAL AND METHODS In 221 patients with THA, two independent readers measured FA, ischiofemoral space (IFS), quadratus femoris space (QFS), edema, and fatty infiltration of quadratus femoris muscle. Three sets of IFI-imaging features were defined: acute IFI (set 1): IFS ≤15 mm or QFS ≤10 mm and edema in the quadratus femoris muscle; chronic IFI (set 2): IFS ≤15 mm or QFS ≤10 mm and fatty infiltration of quadratus femoris muscle Goutallier grade ≥2; acute and chronic IFI (set 3) with both criteria applicable. For each set, FA angles were compared between positive findings of IFI and negative findings of IFI. The t-test for independent samples tested statistical significance. RESULTS In 7.2% (16/221) of patients, findings of IFI (IFS ≤15 mm or QFS ≤10 mm and edema, n = 1; fatty infiltration, n = 9; or both, n = 6) were observed. In women, 11.4% (14/123) exhibited findings of IFI compared to 2.0% (2/98) in men. Comparison in set 1 (n = 7): mean antetorsion of 23.9° ± 9.8° (findings of acute IFI) compared to 14.4° ± 9.7° (P = 0.01). Comparison in set 2 (n = 15): mean antetorsion of 16.2° ± 6.3° (findings of chronic IFI) compared to 14.5° ± 9.9° (P = 0.49). Comparison in set 3 (n = 6): mean antetorsion of 20.4° ± 3.8° (findings of acute and chronic IFI) compared to 14.5° ± 9.9° (P = 0.01). CONCLUSION After THA, high postoperative FA is associated with MRI findings of acute as well as acute and chronic IFI. Findings of IFI were commonly seen in women.
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Affiliation(s)
- Tim Fischer
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christian WA Pfirrmann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Kaiser D, Hoch A, Stern C, Sommer S, Sutter R, Zingg PO. Accuracy of pelvic measurements on virtual radiographic projections based on computed tomography scans compared to conventional radiographs pre- and postoperatively. Arch Orthop Trauma Surg 2022; 143:2965-2971. [PMID: 35767038 DOI: 10.1007/s00402-022-04476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/08/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND The anteroposterior (ap) radiograph of the pelvis is decisive in the diagnosis of different pathologies of the hip joint. Technical advantages have reduced the radiation dose of pelvic CT to levels comparable to radiographs. The purpose of this study was to validate if standard radiographic parameters (lateral center edge angle, medial center edge angle, acetabular index, acetabular arc, extrusion index, crossover sign and posterior wall sign) can accurately be determined on radiograph-like projections reconstructed from the CT dataset pre- and postoperatively. METHODS A consecutive series of patient with symptomatic dysplasia of the hip and a full radiologic workup (radiographs and CT scan pre- and postoperatively) who underwent periacetabular osteotomy were included. Standard radiographic parameters were compared between radiographs and radiograph-like projections by two authors pre- and postoperatively. RESULTS A total of 16 hips (32 radiographs/32 radiograph-like projections) were included in the study. No significant difference was found between the radiographs and radiograph-like images for all parameter for both examiners. ICC between radiograph and radiograph-like projections for all investigated parameters showed good to excellent reliability (0.78-0.99) pre- and postoperatively. CONCLUSION Radiograph-like projections show comparable results to radiographs with regard to the important investigated parameters (lateral center edge angle, medial center edge angle, acetabular index, acetabular arc, extrusion index, crossover sign and posterior wall sign). Thus, ultra-low-dose CT scans may reduce the need for conventional radiographs in pre- and postoperative analyses of 3-dimensional hip pathologies in the future, as the advantages increasingly outweigh the disadvantages.
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Affiliation(s)
- Dominik Kaiser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Sommer
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,Siemens Healthcare, Zurich, Switzerland.,Swiss Center for Musculoskeletal Imaging (SCMI), Balgrist Campus, Zurich, Switzerland.,Advanced Clinical Imaging Technology (ACIT), Siemens Healthcare AG, Lausanne, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Kriechling P, Leoty L, Fürnstahl P, Rahbani D, Zingg PO, Vlachopoulos L. A Statistical Shape Model-Based Analysis of Periacetabular Osteotomies: Technical Considerations to Achieve the Targeted Correction. J Bone Joint Surg Am 2022; 104:1107-1115. [PMID: 35363641 DOI: 10.2106/jbjs.21.00454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Classic and reverse Bernese periacetabular osteotomy (PAO) have been shown to be effective for the treatment of developmental dysplasia of the hip (by classic PAO), severe acetabular retroversion (by reverse PAO), and some protrusio acetabuli (by reverse PAO). Especially in severe cases with higher degrees of correction, a relevant overlap between the osteotomized fragment and the pelvis might occur, leading to necessary fragment translation. The aim of the present study was to analyze the necessary translation as a function of the degree of correction using a statistical mean model of the pelvis according to the technique (classic PAO or reverse PAO). METHODS A mean statistical shape model of the pelvis and 2 extreme models were used to simulate rotation of the osteotomized fragment during a classic or reverse PAO and to calculate rotations from -20° to 20° in the frontal, sagittal, and transverse planes and a combination thereof. The depth and volume of the intersection between the mobilized fragment and the pelvis were calculated, and the minimum translation of the fragment necessary to avoid segment overlap was determined. RESULTS The maximum intersection distances between the pelvis and the 20° rotated fragment were 6.7 and 15.3 mm for adduction and abduction (frontal plane), 6.4 and 4.5 mm for internal and external rotation (transverse plane), and 27.8 and 9.2 mm for extension and flexion (sagittal plane). The necessary translations for 20° of fragment rotation were 7.0 and 12.8 mm for adduction and abduction (frontal plane), 4.8 and 5.0 mm for internal and external rotation (transverse plane), and 18.5 mm and 8.8 mm for extension and flexion (sagittal plane). CONCLUSIONS Acetabular reorientation with the classic or reverse PAO results in translation of the fragment and in a consequent change in the rotational center. This finding is more pronounced with higher degrees of fragment reorientation in abduction and extension; it becomes especially pronounced in reverse PAO for acetabular retroversion or protrusio acetabuli, and might limit the ability to achieve the intended improvement in overall hip biomechanics.
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Affiliation(s)
- Philipp Kriechling
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Laura Leoty
- Research in Orthopaedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedic Computer Science (ROCS), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Dana Rahbani
- Graphics and Vision Research Group (GraVis), University of Basel, Basel, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Walser F, Prinz J, Rahm S, Zingg PO, Mancini S, Imkamp F, Zbinden R, Achermann Y. Antimicrobial susceptibility testing is crucial when treating Finegoldia magna infections. Eur J Clin Microbiol Infect Dis 2022:10.1007/s10096-022-04439-y. [PMID: 35391578 DOI: 10.1007/s10096-022-04439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/24/2022] [Indexed: 11/03/2022]
Abstract
Finegoldia magna is an anaerobic gram-positive bacterium that can cause invasive human infections. Recently, a 52-year-old patient suffering from a periprosthetic joint infection (PJI) due to F. magna was treated with cefepime on hemodialysis; however, treatment failed due to relapse caused by antibiotic-resistant strains. Reports on the antimicrobial susceptibility of F. magna clinical isolates are rare. We collected 57 clinical F. magna isolates from Zurich, Switzerland, between September 2019 and July 2020 and tested their antimicrobial susceptibility to investigate the local resistance pattern. Antimicrobial susceptibility testing (AST) was evaluated for nine antibiotics (benzylpenicillin, amoxicillin/clavulanic acid, cefuroxime, cefepime, levofloxacin, rifampicin, metronidazole, doxycycline, and clindamycin) by E-test according to CLSI guidelines. All F. magna strains were susceptible to benzylpenicillin, amoxicillin/clavulanic acid, and metronidazole, while 75% to clindamycin. F. magna isolates showed MIC values lower than species-unrelated breakpoints for cefuroxime, levofloxacin, and cefepime in 93%, 56%, and 32% of the cases, respectively. MIC values for rifampicin and doxycycline were lower than locally determined ECOFFs in 98% and 72% of the cases, respectively. In summary, we recommend the use of benzylpenicillin, amoxicillin/clavulanic acid, or metronidazole without prior AST as first-line treatment option against F. magna PJI infections. If cefuroxime, cefepime, levofloxacin, rifampicin, doxycycline, or clindamycin are used, AST is mandatory.
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Affiliation(s)
- Fabienne Walser
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Julia Prinz
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
- Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefano Mancini
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Frank Imkamp
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Yvonne Achermann
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
- Dermatology, University Hospital Zurich, University of Zurich And Department of Internfal Medicine, Hospital Zollikerberg, Zollikerberg, Switzerland.
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Bär J, Boumasmoud M, Mairpady Shambat S, Vulin C, Huemer M, Schweizer TA, Gómez-Mejia A, Eberhard N, Achermann Y, Zingg PO, Mestres C, Brugger SD, Schuepbach RA, Kouyos RD, Hasse B, Zinkernagel AS. Quantification of within-patient Staphylococcus aureus phenotypic heterogeneity as a proxy for presence of persisters across clinical presentations. Clin Microbiol Infect 2022; 28:1022.e1-1022.e7. [DOI: 10.1016/j.cmi.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 12/21/2022]
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Flury A, Aregger F, Rahm S, Hoch A, Zingg PO. Subtrochanteric osteotomy in the management of femoral maltorsion results in anteroposterior malcorrection of the greater trochanter: computed simulations of 3D surface models of 100 cadavers. Hip Int 2022; 33:525-532. [PMID: 35067083 PMCID: PMC10170563 DOI: 10.1177/11207000211071046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
AIM The purpose of this study was to investigate the greater trochanter's (GT) behaviour in simulated subtrochanteric osteotomy. MATERIALS AND METHODS Measurement of functional and anatomical femoral torsion, and position of the GT and lesser trochanter was performed using 3-dimensional (3D) surface models of 100 cadaveric femora. Femoral torsion between 2° and 22° was defined as normal, femora with <2° and >22° of femoral torsion were assigned to the low- and high-torsion group. Subtrochanteric osteotomy was simulated to normalise torsional deformities to 12°. RESULTS With subtrochanteric osteotomy, functional torsion was simultaneously corrected while adjusting anatomical torsion (R2 = 0.866, p < 0.001). Compared to the normal-torsion group, an anteroposterior (AP) overcorrection of ±0.5 centimetres (range 0.02-1.1 cm) of the GT resulted in the high- and low-torsion group, respectively (p < 0.001): Mean AP GT distance to a standardised coronal plane was 2.1 ± 0.3 cm (range 12-30 cm) in the normal-torsion group compared to 1.61 ± 0.1 cm (range 1.4-1.71 cm) and 2.6 ± 0.6 cm (range 1.8-3.6 cm) for the corrected high and low-torsion groups, respectively. The extent of the GT shift in AP direction correlated strongly with the extent to which anatomical femoral torsion was corrected (R2 = 0.946; p < 0.001). CONCLUSIONS Subtrochanteric osteotomy for femoral maltorsion reliably adjusts anatomical and functional torsion, but also results in a ±1 cm AP shift of the GT per 10° of torsional correction. However, this effect of the procedure is most likely not clinically relevant in relation to hip abductor performance.
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Affiliation(s)
- Andreas Flury
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Fabian Aregger
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | | | - Armando Hoch
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
| | - Patrick O Zingg
- Andreas Flury, Armando Hoch, Patrick O Zingg and Fabian Aregger contributed equally to this work
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Andronic O, Hincapié CA, Burkhard MD, Loucas R, Loucas M, Ried E, Rahm S, Zingg PO. Lack of Conclusive Evidence of the Benefit of Biologic Augmentation in Core Decompression for Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review. Arthroscopy 2021; 37:3537-3551.e3. [PMID: 33964392 DOI: 10.1016/j.arthro.2021.04.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess whether biologic augmentation in addition to core decompression (CD), compared with CD alone, improves clinical and radiographic outcomes in the treatment of nontraumatic osteonecrosis of the femoral head (ONFH). Our hypothesis was that biologic augmentation would reduce the progression of osteonecrosis and therefore also the rate of conversion to total hip arthroplasty (THA). METHODS A systematic review was performed in accordance with the Preferred Reporting Items of Systematic Reviews and Meta-analysis (PRISMA) statement. Six databases were searched: Central, MEDLINE, Embase, Scopus, AMED, and Web of Science. Studies comparing outcomes of CD versus CD plus biologic augmentation (with or without structural augmentation), with a reported minimum level of evidence of III and ≥24 months of follow-up, were eligible. Procedural success was conceptualized as (1) avoidance of conversion to THA and (2) absence of radiographic disease progression. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal checklists. A quantitative analysis of heterogeneity was undertaken. RESULTS We included studies reporting on 560 hips in 484 patients. Biologic augmentation consisted of bone marrow stem cells in 10 studies, bone morphogenic protein in 2, and platelet-rich plasma in 1. Three studies used additional structural augmentation. The median maximum follow-up time was 45 months. Only 4 studies reported improvement in all clinical scores in the augmentation group. Seven studies observed a reduction in the rate of radiographic progression, and only 5 found reduced rates of conversion to THA when using augmentation. A high risk of bias and marked heterogeneity was found, with uncertainty about the study designs implemented, analytical approaches, and quality of reporting. CONCLUSION Current evidence is inconclusive regarding the benefit of biologic augmentation in CD for nontraumatic ONFH, because of inconsistent results with substantial heterogeneity and high risk of bias. LEVEL OF EVIDENCE III, systematic review of level I, II, and III studies.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland.
| | - Cesar A Hincapié
- Department of Chiropractic Medicine, Faculty of Medicine, Balgrist University Hospital and University of Zurich, Zurich, Switzerland; Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco D Burkhard
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Rafael Loucas
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Marios Loucas
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Emanuel Ried
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
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Abstract
INTRODUCTION Femoral rotational osteotomies can be a treatment option for symptomatic femoral maltorsion. This study investigated the clinical and radiological results of subtrochanteric rotational osteotomy and its potential adverse effects, particularly on patellofemoral stability and geometry. METHODS Retrospective consecutive series of patients undergoing subtrochanteric rotational osteotomy with hip arthroscopy. 25 hips, 18 with decreased (⩽4°), 7 with increased (⩾28°) femoral torsion (FT), were analysed. Mean follow-up was 37 months. Subjective Hip value (SHV), WOMAC and Harris Hip Score (HHS), hip range of motion, asymmetries in foot position during gait as well as patellofemoral instability were the outcome measures. Femoral and tibial torsion as well as morphological signs of patella maltracking (TTTG, patellar tilt and lateralisation) were measured on MRI. RESULTS SHV improved from 52% to 72% (p = 0.002), WOMAC from 3 to 1 (p < 0.001) and HHS from 68 to 86 (p < 0.001). Hips treated for reduced FT showed better internal rotation and hips treated for excessive FT less internal rotation compared to the opposite side. 1 patient demonstrated asymptomatic minor in-toeing. Objective patellofemoral instability was not found except for in 1 patient with bilateral patellofemoral apprehension. FT was normalised (mean 16° ± 9°). Tibial torsion showed normal values. Compared to the opposite side TTTG (p > 0.08), patellar tilt (p > 0.09) and lateralisation (p > 0.26) did not differ. No complications occurred. CONCLUSIONS Subtrochanteric rotational osteotomy with hip arthroscopy improves the hip subjectively without leading to objective patellofemoral instability nor changes in the patellofemoral geometry compared to contralateral side. The technique of subtrochanteric rotational osteotomy is safe and reliable.
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Affiliation(s)
- Dominic Rigling
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Claudio Dora
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Abstract
The aim of this study was to evaluate whether new tissue formation occurs after labral debridement/excision, and, if so, which morphological features are typical for a neo-labrum. The authors further compared the findings after labrum resection with those seen after labrum refixation. Patients with femoroacetabular impingement who underwent hip arthroscopy or surgical hip dislocation to address a labrum pathology were retrospectively included, and postoperative magnetic resonance arthrography studies were assessed. Forty-two patients had undergone either labrum resection (n=25) or refixation (n=17), performed arthroscopically (47.6%) or via surgical hip dislocation (52.4%). In the subgroup of patients after debridement/resection, there was anterosuperior/superior scar tissue in 83.5%, with amorphous configuration in 92%, irregular surface in approximately two-thirds of the cases, and a mean±SD thickness of 7.0±2.7 mm. A labrum-like shape of the scar plate was seen in 7.7%. Regarding the subgroup of patients who had undergone labral refixation, an irregular or rounded labrum shape was noted in 26.5% and 51.3% of cases, respectively, with a triangular shape in less than one-fourth of cases. Labrum re-tears (35.7%) were mainly observed at the base (71.7%), rather than within the labral substance (28.4%). New tissue formation can be observed in the majority of cases after excision of the hip labrum, with amorphous and irregular surface configuration compared with a native labrum. This new tissue should therefore be referred to as scar tissue rather than as neo-labrum. Whether scar tissue is inferior to a refixed labrum needs to be further elucidated in follow-up studies. [Orthopedics. 2021;44(4):e607-e613.].
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Andronic O, Rahm S, Fritz B, Singh S, Sutter R, Zingg PO. External snapping hip syndrome is associated with an increased femoral offset. Eur J Orthop Surg Traumatol 2021; 32:1481-1489. [PMID: 34550475 PMCID: PMC9587962 DOI: 10.1007/s00590-021-03123-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
Background External snapping hip syndrome (ESH) is postulated to be one of the causes of greater trochanteric pain syndrome, which also includes greater trochanteric bursitis and tendinopathy or tears of the hip abductor mechanism. However, it was not yet described what kind of bony morphology can cause the snapping and whether symptomatic and asymptomatic individuals have different imaging features. Purpose It was the purpose of this study to look for predisposing morphological factors for ESH and to differentiate between painful and asymptomatic snapping. Methods A consecutive cohort with ESH and available magnetic resonance imaging (MRI) between 2014 and 2019 was identified. The control group consisted of patients that underwent corrective osteotomies around the knee for mechanical axis correction and never complained of hip symptoms nor had undergone previous hip procedures. The following parameters were blindly assessed for determination of risk factors for ESH: CCD (corpus collum diaphysis) angle; femoral and global offset; femoral antetorsion; functional femoral antetorsion; translation of the greater trochanter (GT); posterior tilt of the GT; pelvic width/anterior pelvic length; intertrochanteric width. Hip and pelvic offset indexes were calculated as ratios of femoral/global offset and intertrochanteric/pelvic width, respectively. For the comparison of symptomatic and asymptomatic snapping, the following soft-tissue signs were investigated: presence of trochanteric bursitis or gluteal tendinopathy; presence of surface bony irregularities on trochanter major and ITB (Iliotibial band) thickness. Results A total of 31 hips with ESH were identified. The control group (n = 29) consisted of patients matched on both age (± 1) and gender. Multiple regression analysis determined an increased hip offset index to be independent predictor of ESH (r = + 0.283, p = 0.025), most likely due to the higher femoral offset in the ESH group (p = 0.031). Pearson correlation analysis could not identify any significant secondary factors. No differences were found between painful and asymptomatic snapping on MRI. Conclusions A high hip offset index was found as an independent predictor for external snapping hip in our cohort, mainly due to increased femoral offset. No imaging soft-tissue related differences could be outlined between symptomatic and asymptomatic external snapping. Level of evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00590.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sarvpreet Singh
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Hoch A, Schenk P, Jentzsch T, Rahm S, Zingg PO. FAI morphology increases the risk for osteoarthritis in young people with a minimum follow-up of 25 years. Arch Orthop Trauma Surg 2021; 141:1175-1181. [PMID: 32601879 DOI: 10.1007/s00402-020-03522-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/21/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The mechanical conflict in symptomatic femoroacetabular impingement can lead to early osteoarthritis. However, radiographic impingement morphology is often seen in asymptomatic individuals. Long-term observation regarding the risk of developing osteoarthritis in these individuals is lacking. Our study addressed the following questions: Does femoroacetabular impingement morphology increase the risk for development of osteoarthritis after at least 25 years? If yes, which radiographic parameter is the most predictive? Does the level of activity influence the risk for development of osteoarthritis? Are PROM influenced by the grade of osteoarthritis in this population? METHODS We investigated 51 (32 male, 19 female) patients for whom AP pelvis and Dunn view radiographs were available with a minimum follow-up of 25 years. Alpha angle in AP pelvis and Dunn view radiographs, femoral torsion in Dunn view, lateral center edge angle, cross-over sign, posterior wall sign and prominence of ischial spine sign in AP pelvis radiographs were determined. On the follow-up radiographs, osteoarthritis was graded. Tegner Score for the time of the index radiograph was evaluated. Harris Hip Score and Western Ontario and McMaster Universities Osteoarthritis Index were assessed at latest follow-up. RESULTS The mean follow-up was 43 years (range 25-58). Cam impingement morphology showed to increase the risk for development of osteoarthritis: Alpha angles of ≥ 55° on AP pelvis and Dunn view radiographs were associated risk factors and showed an OR of 1.05 (p = 0.002) and 1.10 (p = 0.001), respectively. Abnormal femoral torsion and acetabular retroversion were not risk factors for osteoarthritis. Tegner Score at index presentation, HHS and WOMAC Score did not correlate with the grade of osteoarthritis. CONCLUSION This study showed that cam impingement morphology in young patients raises the risk for development of hip osteoarthritis by 5-10% in a long-term follow-up with a minimum of 25 years, thus its contribution was small.
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Affiliation(s)
- Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Pascal Schenk
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Hasler J, Hoch A, Fürnstahl P, Ackermann J, Zingg PO, Vlachopoulos L. Is the contralateral lesser trochanter a reliable reference for planning of total hip arthroplasty - a 3-dimensional analysis. BMC Musculoskelet Disord 2021; 22:268. [PMID: 33706727 PMCID: PMC7953689 DOI: 10.1186/s12891-021-04131-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
Background Preoperative templating in total hip arthroplasty (THA) is mandatory to achieve appropriate offset and leg length equality. However, templating methods using the contralateral hip might be susceptible to errors resulting from side-differences in the femoral morphology. The distance of the lesser trochanter to the femoral head center (LTFHD) is a frequently used reference parameter for preoperative planning and intraoperative validation during THA. However, currently no three-dimensional (3D) analysis of side differences of the LTFHD exists. Methods Using Computer tomography (CT)-based surface models from 100 paired femora (50 cadavers), side-to-side asymmetry of the LTFHD, femoral length, femoral head diameter (FHD) and femoral antetorsion were analyzed. Univariate linear regression models were established to evaluate potential associations between sides regarding LTFHD and FHD as well as a correlation of these parameters with each other. Results Statistically significant side-differences were found for the LTFHD (p = 0.02) and FHD (p = 0.03) with a mean absolute side-difference of 1.6 ± 1.4mm (range 0.1–5.5mm) and 0.4mm ± 0.6mm (range 0–3mm), respectively. The ratio between the LTFHD and FHD was consistent with an average value of 1.16 ± 0.08 and reliable between sides with a correlation coefficient (r) of 0.72 (p < 0.01). Conclusions The LTFHD is a reliable reference parameter for preoperative templating and intraoperative validation during THA with a high correlation between sides (r = 0.93, p < 0.01). However, 8 % of the investigated specimens revealed a LTFHD of more than 4mm, which should be anticipated during THA to avoid unsatisfiable results.
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Affiliation(s)
- Julian Hasler
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland.
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopaedics Computer Science, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jakob Ackermann
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
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Waibel FWA, Berndt K, Jentzsch T, Farei-Campagna J, Rahm S, Dora C, Zingg PO. Symptomatic leg length discrepancy after total hip arthroplasty is associated with new onset of lower back pain. Orthop Traumatol Surg Res 2021; 107:102761. [PMID: 33316448 DOI: 10.1016/j.otsr.2020.102761] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Leg length discrepancy (LLD) is common after total hip arthroplasty (THA) with a plethora of clinical consequences. The associations between symptomatic (sLLD; disturbing perception of anatomical leg length discrepancy), anatomical (aLLD; side difference in leg length between the center of rotation of the hip and the center of the ankle joint) and intraarticular (iLLD; side difference between the tear drop figure and the most prominent point of the trochanter minor) LLD and lower back have not yet been reported in the literature. We performed a retrospective study to answer if postoperative (1) symptomatic LLD, (2) anatomic LLD, and (3) a change in intraarticular leg length are associated with lower back pain in patients undergoing THA. Further, we aimed to answer (4) whether symptomatic LLD is associated with the magnitude of anatomical LLD and the change in intraarticular leg length. HYPOTHESIS LLD after THA is associated with lower back pain. MATERIALS AND METHODS Seventy-nine consecutive patients were retrospectively analyzed for the presence of aLLD and iLLD using EOS™ and X-rays, and were interviewed for the presence of sLLD and lower back pain using a questionnaire 5 years after primary THA. RESULTS Postoperative new onset of lower back pain was reported by 9 (11%) patients. Twenty (25%) patients reported sLLD. Anatomical LLD>5mm was present in 44 (56%) (median 8.0 (IQR -3.0 to 12.0; range -22 to 22) mm) and>10mm in 17 (22%) (median 12.0 (IQR 11.0 to 16.5; range -22 to 22) mm) patients. iLLD changed>5mm in 44 (56%) (median 8.5 (IQR 7.0 to 10.0; range -8 to 18) mm) and>10mm in 10 (13%) (median 14.0 (IQR 12.5 to 14.5; range 11 to 18) mm). New onset lower back pain was associated with sLLD (p=0.002) but not with aLLD or iLLD. Patients without preoperative lower back pain had a statistically significant association between presence of sLLD and an aLLD of >10mm (p=0.01). CONCLUSIONS Symptomatic LLD after primary THA is associated with postoperative new onset of lower back pain irrespective of the magnitude of LLD. In patients without lower back pain prior to THA, symptomatic LLD is associated with anatomical LLD of more than 10mm. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Felix W A Waibel
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.
| | - Kersten Berndt
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Jan Farei-Campagna
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Claudio Dora
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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Maurer SM, Kursawe L, Rahm S, Prinz J, Zinkernagel AS, Moter A, Kuster SP, Zbinden R, Zingg PO, Achermann Y. Cutibacterium avidum resists surgical skin antisepsis in the groin-a potential risk factor for periprosthetic joint infection: a quality control study. Antimicrob Resist Infect Control 2021; 10:27. [PMID: 33522957 PMCID: PMC7852298 DOI: 10.1186/s13756-021-00883-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The skin commensal Cutibacterium avidum has been recognized as an emerging pathogen for periprosthetic joint infections (PJI). One currently assumes that the early occurring PJIs are a consequence of skin commensals contaminating the peri-implant tissue during surgery. We addressed whether standard skin antisepsis with povidone-iodine/alcohol before total hip arthroplasty (THA) is effective to eliminate colonizing bacteria with focus on C. avidum. METHODS In a single-center, prospective study, we screened all patients for skin colonizing C. avidum in the groin before THA. Only in the patients positive for C. avidum, we preoperatively repeated skin swabs after the first and third skin antisepsis and antibiotic prophylaxis. We also obtained dermis biopsies for microbiology and fluorescence in situ hybridization (FISH). RESULTS Fifty-one out of 60 patients (85%) were colonized on the skin with various bacteria, in particular with C. avidum in 12 out of 60. Skin antisepsis eliminated C. avidum in eight of ten (20%) colonized patients undergoing THA. Deeper skin (dermis) biopsies were all culture negative, but FISH detected single positive ribosome-rich C. avidum in one case near sweat glands. CONCLUSION Standard skin antisepsis was not effective to completely eliminate colonizing C. avidum on the skin in the groin of patients undergoing THA. Colonizing with C. avidum might pose an increased risk for PJI when considering a THA. Novel more effective antisepsis strategies are needed. Trial registration No clinical trial.
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Affiliation(s)
- Steven M Maurer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Kursawe
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan Rahm
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Julia Prinz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Dermatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annette Moter
- Institute of Microbiology, Infectious Diseases and Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, University Hospital Balgrist, Zurich, Switzerland
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Rahm S, Hoch A, Tondelli T, Fuchs J, Zingg PO. Revision rate of THA in patients younger than 40 years depends on primary diagnosis - a retrospective analysis with a minimum follow-up of 10 years. Eur J Orthop Surg Traumatol 2021; 31:1335-1344. [PMID: 33495905 PMCID: PMC8448705 DOI: 10.1007/s00590-021-02881-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/15/2021] [Indexed: 01/12/2023]
Abstract
Background Treating osteoarthritis in elderly patients with THA is very successful. However, surgeons hesitate to recommend THA in younger patients. The spectrum of etiologies for end stage hip disease in the younger population is diverse and therefore different courses may be assumed. Our objective was to evaluate THA revision rate within a minimum follow-up period of 10 years in young patients and to analyze the difference between different primary diagnoses. Methods We included 144 consecutive hips in 127 patients younger than 40 years, who received a primary THA from 01/1996 to 12/2007. Operative reports, clinical and radiographic documentation were reviewed to determine primary diagnosis, prior hip surgery, component specifications and revision surgery. 111 hips in 97 patients were available for outcome analysis with a minimum follow-up of 10 years. Results The mean age was 33 years (range 15–40 years) at the time of the index THA, 68 patients were female and 59 were male. Ten years revision rate on the prosthetic components was 13%. The most common primary diagnosis was DDH. DDH was associated with a risk of 17% for requiring a reoperation on the prosthetic components because of mechanical fatigue and therefore, significantly higher than for any other primary diagnosis (p = 0.005). Conclusion THA in young patients is associated with a high revision rate of 13% in 10 years. 17% of patients with DDH required revision surgery for mechanical fatigue within 10 years, which was significantly higher than for any other primary diagnosis (1.2%, OR 16.8).
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Armando Hoch
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Johannes Fuchs
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
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Castro MO, Mascarenhas VV, Afonso PD, Rego P, Schmaranzer F, Sutter R, Kassarjian A, Sconfienza L, Dienst M, Ayeni OR, Beaulé PE, Dantas P, Lalam R, Weber MA, Vanhoenacker FM, Dietrich TJ, Jans L, Robinson P, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Llopis E. The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 3: imaging techniques. Eur Radiol 2021; 31:4652-4668. [PMID: 33411053 DOI: 10.1007/s00330-020-07501-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/19/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Imaging diagnosis of femoroacetabular impingement (FAI) remains controversial due to a lack of high-level evidence, leading to significant variability in patient management. Optimizing protocols and technical details is essential in FAI imaging, although challenging in clinical practice. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal consensus techniques driven by relevant literature review. Recommendations on the selection and use of imaging techniques for FAI assessment, as well as guidance on relevant radiographic and MRI classifications, are provided. METHODS The Delphi method was used to assess agreement and derive consensus among 30 panel members (musculoskeletal radiologists and orthopedic surgeons). Forty-four questions were agreed on and classified into five major topics and recent relevant literature was circulated, in order to produce answering statements. The level of evidence was assessed for all statements and panel members scored their level of agreement with each statement during 4 Delphi rounds. Either "group consensus," "group agreement," or "no agreement" was achieved. RESULTS Forty-seven statements were generated and group consensus was reached for 45. Twenty-two statements pertaining to "Imaging techniques" were generated. Eight statements on "Radiographic assessment" and 12 statements on "MRI evaluation" gained consensus. No agreement was reached for the 2 "Ultrasound" related statements. CONCLUSION The first international consensus on FAI imaging was developed. Researchers and clinicians working with FAI and hip-related pain may use these recommendations to guide, develop, and implement comprehensive, evidence-based imaging protocols and classifications. KEY POINTS • Radiographic evaluation is recommended for the initial assessment of FAI, while MRI with a dedicated protocol is the gold standard imaging technique for the comprehensive evaluation of this condition. • The MRI protocol for FAI evaluation should include unilateral small FOV with radial imaging, femoral torsion assessment, and a fluid sensitive sequence covering the whole pelvis. • The definite role of other imaging methods in FAI, such as ultrasound or CT, is still not well defined.
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Affiliation(s)
- Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Sítio do Poço Seco, Portimão, 8500-338, Portugal.
| | - Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Reto Sutter
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Luca Sconfienza
- RCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Apostolos H Karantanas
- Medical School-University of Crete and Computational BioMedicine Laboratory-ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR), Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland
- The University of Notre Dame Australia, Sydney School of Medicine, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
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Mascarenhas VV, Castro MO, Afonso PD, Rego P, Dienst M, Sutter R, Schmaranzer F, Sconfienza L, Kassarjian A, Ayeni OR, Beaulé PE, Dantas P, Lalam R, Weber MA, Vanhoenacker FM, Dietrich TJ, Jans L, Robinson P, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Llopis E. The Lisbon Agreement on femoroacetabular impingement imaging-part 2: general issues, parameters, and reporting. Eur Radiol 2021; 31:4634-4651. [PMID: 33411052 DOI: 10.1007/s00330-020-07432-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/13/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Imaging assessment for the clinical management of femoroacetabular impingement (FAI) is controversial because of a paucity of evidence-based guidance and notable variability among practitioners. Hence, expert consensus is needed because standardised imaging assessment is critical for clinical practice and research. We aimed to establish expert-based statements on FAI imaging by using formal methods of consensus building. METHODS The Delphi method was used to formally derive consensus among 30 panel members from 13 countries. Forty-four questions were agreed upon, and relevant seminal literature was circulated and classified in major topics to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement (0-10). This is the second part of a three-part consensus series and focuses on 'General issues' and 'Parameters and reporting'. RESULTS Forty-seven statements were generated and group consensus was reached for 45. Twenty-five statements pertaining to 'General issues' (9 addressing diagnosis, differential diagnosis, and postoperative imaging) and 'Parameters and reporting' (16 addressing femoral/acetabular parameters) were produced. CONCLUSIONS The available evidence was reviewed critically, recommended criteria for diagnostic imaging highlighted, and the roles/values of different imaging parameters assessed. Radiographic evaluation (AP pelvis and a Dunn 45° view) is the cornerstone of hip-imaging assessment and the minimum imaging study that should be performed when evaluating adult patients for FAI. In most cases, cross-sectional imaging is warranted because MRI is the 'gold standard' imaging modality for the comprehensive evaluation, differential diagnosis assessment, and FAI surgical planning. KEY POINTS • Diagnostic imaging for FAI is not standardised due to scarce evidence-based guidance on which imaging modalities and diagnostic criteria/parameters should be used. • Radiographic evaluation is the cornerstone of hip assessment and the minimum study that should be performed when assessing suspected FAI. Cross-sectional imaging is justified in most cases because MRI is the 'gold standard' modality for comprehensive FAI evaluation. • For acetabular morphology, coverage (Wiberg's angle and acetabular index) and version (crossover, posterior wall, and ischial spine signs) should be assessed routinely. On the femoral side, the head-neck junction morphology (α° and offset), neck morphology (NSA), and torsion should be assessed.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Radiology Department, Imaging Center, Hospital da Luz, Grupo Luz Saúde, Av Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - P Diana Afonso
- Musculoskeletal Imaging Unit, Radiology Department, Imaging Center, Hospital da Luz, Grupo Luz Saúde, Av Lusiada 100, 1500-650, Lisbon, Portugal
| | - Paulo Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | | | - Reto Sutter
- Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Luca Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Filip M Vanhoenacker
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
- Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK
- University of Leeds and NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Apostolos H Karantanas
- Medical School-University of Crete and Computational BioMedicine Laboratory-ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation (NIGRiR), Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland
- The University of Notre Dame Australia, Sydney School of Medicine, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
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Rahm S, Jud L, Jungwirth-Weinberger A, Tondelli T, Falkowski AL, Sutter R, Zingg PO. Mid-term results after in situ pinning and hip arthroscopy for mild slipped capital femoral epiphysis: a minimum five-year follow-up. J Child Orthop 2020; 14:521-528. [PMID: 33343747 PMCID: PMC7740677 DOI: 10.1302/1863-2548.14.200068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE In situ pinning of mild slipped capital femoral epiphysis (SCFE) results in an aspherical head-neck junction and arthroscopic osteochondroplasty can successfully correct the head-neck junction. However, whether the correction stays stable over at least five years remains unknown. METHODS In a retrospective and consecutive series, 11 patients with a mean age of 12 years (range, 10 years to 15 years) were included. All patients were treated for mild SCFE with in situ pinning and staged hip arthroscopy correcting the head-neck junction. All patients were assessed clinically and radiographically (radiograph and magnetic resonance imaging (MRI)) pre-operatively, 12 weeks and at least five years' post-operatively. RESULTS The mean range of motion (ROM) for flexion and internal rotation was stable over time with 100° (sd 4) and 21° (sd 6), respectively at the last follow-up. The mean alpha angle decreased from pre-operative 64° (range 61° to 68°) to 12 weeks post-operative 49° (range 46° to 52°; p = 0.001) and stayed stable over time. New superficial cartilage damage on either the acetabular or femoral side was seen in each three patients. Progressive labral degeneration was present in two patients. CONCLUSION In situ pinning and staged hip arthroscopy for the correction of mild SCFE is safe, restores normal alpha angles and reveals stable morphological correction at mid-term follow-up. Furthermore, the clinical results were excellent with almost normalized internal hip rotation at mid-term follow-up in patients who had reached adulthood. However, there was some joint deterioration, but without negative impact on subjective and clinical outcome after at least five years. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland,Correspondence should be sent to Stefan Rahm, Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, Zurich 8008, Switzerland. E-mail:
| | - Lukas Jud
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Timo Tondelli
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna L. Falkowski
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Kiarostami P, Dennler C, Roner S, Sutter R, Fürnstahl P, Farshad M, Rahm S, Zingg PO. Augmented reality-guided periacetabular osteotomy-proof of concept. J Orthop Surg Res 2020; 15:540. [PMID: 33203429 PMCID: PMC7672946 DOI: 10.1186/s13018-020-02066-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 11/04/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The Ganz' periacetabular osteotomy (PAO) consists of four technically challenging osteotomies (OT), namely, supraacetabular (saOT), pubic (pOT), ischial (iOT), and retroacetabular OT (raOT). PURPOSE We performed a proof of concept study to test (1) the feasibility of augmented reality (AR) guidance for PAO, (2) precision of the OTs guided by AR compared to the freehand technique performed by an experienced PAO surgeon, and (3) the effect of AR on performance depending on experience. METHODS A 3D preoperative plan of a PAO was created from segmented computed tomography (CT) data of an anatomic plastic pelvis model (PPM). The plan was then embedded in a software application for an AR head-mounted device. Soft tissue coverage was imitated using foam rubber. The 3D plan was then registered onto the PPM using an anatomical landmark registration. Two surgeons (one experienced and one novice PAO surgeon) each performed 15 freehand (FH) and 15 AR-guided PAOs. The starting point distances and angulation between the planned and executed OT planes for the FH and the AR-guided PAOs were compared in post-intervention CTs. RESULTS AR guidance did not affect the performance of the expert surgeon in terms of the mean differences between the planned and executed starting points, but the raOT angle was more accurate as compared to FH PAO (p = 0.0027). AR guidance increased the accuracy of the performance of the novice surgeon for iOT (p = 0.03). An intraarticular osteotomy performed by the novice surgeon with the FH technique could be observed only once. CONCLUSION AR guidance of osteotomies for PAOs is feasible and seems to increase accuracy. The effect is more accentuated for less-experienced surgeons. CLINICAL RELEVANCE This is the first proof of concept study documenting the feasibility of AR guidance for PAO. Based on these findings, further studies are essential for elaborating on the potential merits of AR guidance to increase the accuracy of complex surgical procedures.
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Affiliation(s)
- Pascal Kiarostami
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Cyrill Dennler
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Simon Roner
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Philipp Fürnstahl
- Computer Assisted Research & Development Group, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Mazda Farshad
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Forchstrasse 340, 8008 Zürich, Switzerland
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Andronic O, Achermann Y, Jentzsch T, Bearth F, Schweizer A, Wieser K, Fucentese SF, Rahm S, Zinkernagel AS, Zingg PO. Factors affecting outcome in the treatment of streptococcal periprosthetic joint infections: results from a single-centre retrospective cohort study. Int Orthop 2020; 45:57-63. [PMID: 32856092 PMCID: PMC7801309 DOI: 10.1007/s00264-020-04722-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To report and analyse factors affecting the outcome of streptococcal periprosthetic joint infections (PJIs). METHODS A retrospective analysis of consecutive streptococcal PJIs was performed. Musculoskeletal Infection Society 2013 criteria were used. Outcome was compared with a prospective PJI cohort from the same institution. RESULTS The most common isolated streptococcal species was Streptococcus dysgalactiae (9/22, 41%) among 22 patients included. Surgical treatment consisted of DAIR (debridement, antibiotics, irrigation and retention) in 12 (55%), one-stage revision arthroplasty in one (4%), two-stage revision arthroplasty in eight (37%) and implant removal in one (4%) patient. An infection free-outcome was achieved in 15 cases (68%), whilst seven (32%) patients failed initial revision and relapsed with the same pathogen, from which six were treated with DAIR and one with one-stage revision arthroplasty. No failures were observed in patients who received a two-stage revision. Failure rates did not differ in the cases treated with rifampin (1/5) from those without 6/17 (p = 0.55). There was no correlation between the length of antibiotic treatment and relapse (p = 0.723). In all failures, a persistent distant infection focus was identified at the time of relapse. Compared with our prospective PJI cohort, relapse rates were significantly higher 32% vs 12% (p < 0.05). CONCLUSION No correlation with the use of rifampin or length of antibiotic treatment was found. No failures were observed in patients who received a two-stage revision, which may be the surgical treatment of choice. A distant persisting infection focus could be the reason for PJI relapse with recurrent hematogenous seeding in the joint.
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Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Thorsten Jentzsch
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Flurin Bearth
- University of Zurich, Rämistrasse 71, 8006, Zürich, Switzerland
| | - Andreas Schweizer
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Karl Wieser
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Stefan Rahm
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Mascarenhas VV, Castro MO, Rego PA, Sutter R, Sconfienza LM, Kassarjian A, Schmaranzer F, Ayeni OR, Dietrich TJ, Robinson P, Weber MA, Beaulé PE, Dienst M, Jans L, Lalam R, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Vanhoenacker FM, Dantas P, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Llopis E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Afonso PD. Correction to: The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview. Eur Radiol 2020; 30:6966-6967. [PMID: 32681363 DOI: 10.1007/s00330-020-07009-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article, published on 14 May 2020, unfortunately contained a mistake.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Paulo A Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK.,University of Leeds, Leeds, UK.,NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Apostolos H Karantanas
- Medical School, University of Crete, Heraklion, Greece.,Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, Rheumatology and Rehabilitation, National Institute of Geriatrics, Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland.,Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Filip M Vanhoenacker
- Department of Radiology, Ghent University Hospital, Ghent, Belgium.,Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| | | | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
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Mascarenhas VV, Castro MO, Rego PA, Sutter R, Sconfienza LM, Kassarjian A, Schmaranzer F, Ayeni OR, Dietrich TJ, Robinson P, Weber MA, Beaulé PE, Dienst M, Jans L, Lalam R, Karantanas AH, Sudoł-Szopińska I, Anderson S, Noebauer-Huhmann I, Vanhoenacker FM, Dantas P, Marin-Peña O, Collado D, Tey-Pons M, Schmaranzer E, Llopis E, Padron M, Kramer J, Zingg PO, De Maeseneer M, Afonso PD. The Lisbon Agreement on Femoroacetabular Impingement Imaging-part 1: overview. Eur Radiol 2020; 30:5281-5297. [PMID: 32405754 DOI: 10.1007/s00330-020-06822-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/28/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Imaging assessment for the clinical management of femoroacetabular impingement (FAI) syndrome remains controversial because of a paucity of evidence-based guidance and notable variability in clinical practice, ultimately requiring expert consensus. The purpose of this agreement is to establish expert-based statements on FAI imaging, using formal techniques of consensus building. METHODS A validated Delphi method and peer-reviewed literature were used to formally derive consensus among 30 panel members (21 musculoskeletal radiologists and 9 orthopaedic surgeons) from 13 countries. Forty-four questions were agreed on, and recent relevant seminal literature was circulated and classified in five major topics ('General issues', 'Parameters and reporting', 'Radiographic assessment', 'MRI' and 'Ultrasound') in order to produce answering statements. The level of evidence was noted for all statements, and panel members were asked to score their level of agreement with each statement (0 to 10) during iterative rounds. Either 'consensus', 'agreement' or 'no agreement' was achieved. RESULTS Forty-seven statements were generated, and group consensus was reached for 45 (95.7%). Seventeen of these statements were selected as most important for dissemination in advance. There was no agreement for the two statements pertaining to 'Ultrasound'. CONCLUSION Radiographic evaluation is the cornerstone of hip evaluation. An anteroposterior pelvis radiograph and a Dunn 45° view are recommended for the initial assessment of FAI although MRI with a dedicated protocol is the gold standard imaging technique in this setting. The resulting consensus can serve as a tool to reduce variability in clinical practices and guide further research for the clinical management of FAI. KEY POINTS • FAI imaging literature is extensive although often of low level of evidence. • Radiographic evaluation with a reproducible technique is the cornerstone of hip imaging assessment. • MRI with a dedicated protocol is the gold standard imaging technique for FAI assessment.
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Affiliation(s)
- Vasco V Mascarenhas
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal.
| | - Miguel O Castro
- Department of Radiology, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Paulo A Rego
- Department of Orthopaedic Surgery, Hospital da Luz, Lisbon, Portugal
| | - Reto Sutter
- Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
| | | | - Florian Schmaranzer
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern, University of Bern, Bern, Switzerland
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | | | - Philip Robinson
- Radiology Department, Leeds Teaching Hospitals, Chapel Allerton Hospital, Leeds, UK.,University of Leeds, Leeds, UK.,NHIR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, University Medical Center, Rostock, Germany
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lennart Jans
- Department of Radiology, Ghent University Hospital, Gent, Belgium
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Apostolos H Karantanas
- Medical School, University of Crete, Heraklion, Greece.,Computational BioMedicine Laboratory, ICS/FORTH, Heraklion, Greece
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Suzanne Anderson
- Institute of Radiology, Kantonsspital Baden, Baden, Switzerland.,Sydney School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Iris Noebauer-Huhmann
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Filip M Vanhoenacker
- Department of Radiology, Ghent University Hospital, Gent, Belgium.,Department of Radiology, Antwerp University Hospital, Edegem, Belgium.,Department of Radiology, AZ Sint-Maarten, Mechelen, Belgium
| | | | - Oliver Marin-Peña
- Orthopedic and Traumatology Department, Hip Unit, University Hospital Infanta Leonor, Madrid, Spain
| | - Diego Collado
- Cirugía Ortopédica y Traumatología, Centro Médico Teknon, Barcelona, Spain
| | - Marc Tey-Pons
- Department of Orthopedic Surgery and Traumatology, University Hospital del Mar, Barcelona, Spain
| | | | - Eva Llopis
- Department of Radiology, Hospital de la Ribera, Valencia, Spain
| | - Mario Padron
- Department of Radiology, Clínica Cemtro, Madrid, Spain
| | - Josef Kramer
- Röntgeninstitut am Schillerpark, Rainerstrasse, Linz, Austria
| | - Patrick O Zingg
- Department of Orthopaedics, Balgrist University Hospital, Zurich, Switzerland
| | | | - P Diana Afonso
- Musculoskeletal Imaging Unit, Imaging Center, Radiology Department, Hospital da Luz, Grupo Luz Saúde, Av. Lusiada 100, 1500-650, Lisbon, Portugal
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Jud L, Andronic O, Vlachopoulos L, Fucentese SF, Zingg PO. Mal-angulation of femoral rotational osteotomies causes more postoperative sagittal mechanical leg axis deviation in supracondylar than in subtrochanteric procedures. J Exp Orthop 2020; 7:46. [PMID: 32607800 PMCID: PMC7326744 DOI: 10.1186/s40634-020-00262-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 06/11/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Alteration of the postoperative frontal mechanical leg axis is a known problem in femoral rotational osteotomies. However, the maintenance of the sagittal mechanical leg axis seems also important. Goal of this study was to investigate the impact of femoral rotational osteotomies on the sagittal mechanical leg axis and to identify the degree of mal-angulation of the osteotomy planes that alter the postoperative sagittal alignment relevantly. METHODS Using 3D bone models of two patients with a pathologic femoral torsion (42° antetorsion and 6° retrotorsion), subtrochanteric and supracondylar rotational osteotomies were simulated first with an osteotomy plane perpendicular to the mechanical femoral axis (baseline osteotomy plane), second with predefined mal-angulated osteotomy planes. Subsequently, five different degrees of rotation were applied and the postoperative deviations of the sagittal mechanical leg axes were analyzed. RESULTS Using the baseline osteotomy plane, the sagittal mechanical leg axis changed by 0.4° ± 0.5° over both models. Using the mal-angulated osteotomy planes, maximum deviation of the sagittal mechanical leg axis of 4.0° ± 1.2° and 11.0° ± 2.0° was observed for subtrochanteric and for supracondylar procedures, respectively. Relevant changes of more than 2° were already observed with mal-angulation of 10° in the frontal plane and 15° of rotation in supracondylar procedures. CONCLUSION Relevant changes of the postoperative sagittal mechanical leg axis could be observed with just slight mal-angulation of the osteotomy planes, in particular in supracondylar procedures and in cases with higher degrees of rotation. However, osteotomies perpendicular to the femoral mechanical axis showed no relevant alterations.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Octavian Andronic
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
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47
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Weigelt L, Plate A, Stadler L, Sutter R, Frustaci D, Zbinden R, Zingg PO, Gerber C, Achermann Y. Alpha-defensin lateral flow test does not appear to be useful in predicting shoulder periprosthetic joint infections. Int Orthop 2020; 44:1023-1029. [PMID: 32172315 DOI: 10.1007/s00264-020-04532-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/04/2020] [Indexed: 01/16/2023]
Abstract
PURPOSE Periprosthetic joint infections (PJIs) remain a challenging complication after shoulder arthroplasty. The antimicrobial peptide α-defensin has been proposed as a new synovial fluid biomarker in diagnosing PJIs. To date, only little data are available on the diagnostic accuracy of α-defensin in shoulder PJIs; thus, we aimed to evaluate its diagnostic value in a cohort of patients with a suspected shoulder PJI. METHODS Between June 2016 and June 2018, we prospectively enrolled patients with a diagnostic shoulder aspiration due to painful shoulder arthroplasty or planned revision surgery. PJI diagnostics were performed according to the Musculoskeletal Infection Society (MSIS) criteria. All patients with an antibiotic therapy within two weeks before enrollment, insufficient amount of synovial aspirate, or bloody aspiration were excluded. α-Defensin was measured in the synovial fluid using the α-defensin lateral flow (ADLF) test (Synovasure®). RESULTS Out of 60 patients, we could include 29 (59% female) patients with a mean age of 70 (range, 50-92) years. A shoulder PJI was detected in five cases (Staphylococcus aureus, n = 2; Staphylococcus epidermidis, n = 2; Cutibacterium acnes, n = 1). The ADLF test was positive in seven out of 29 cases. According to the MSIS criteria, the ADLF test was false-negative in two patients and false-positive in four patients, resulting in sensitivity, specificity, and positive and negative predictive value of 60%, 83%, 43%, and 91%, respectively. The overall accuracy was 79%. CONCLUSION The ALDF test does not appear to be useful in predicting shoulder PJIs but may be used as an additional diagnostic factor in rejecting these infections.
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Affiliation(s)
- Lizzy Weigelt
- Department of Orthopedics Surgery , University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland.
| | - Andreas Plate
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Laura Stadler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, University Hospital Balgrist, University of Zurich, Zurich, Switzerland
| | - Dario Frustaci
- Department of Orthopedics Surgery , University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics Surgery , University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian Gerber
- Department of Orthopedics Surgery , University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Yvonne Achermann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Jud L, Vlachopoulos L, Häller TV, Fucentese SF, Rahm S, Zingg PO. The impact of mal-angulated femoral rotational osteotomies on mechanical leg axis: a computer simulation model. BMC Musculoskelet Disord 2020; 21:50. [PMID: 31973718 PMCID: PMC6979061 DOI: 10.1186/s12891-020-3075-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 01/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Subtrochanteric or supracondylar femoral rotational osteotomies are established surgical treatments for femoral rotational deformities. Unintended change of the mechanical leg axis is an identified problem. Different attempts exist to plan a correct osteotomy plane, but implementation of the preoperative planning into the surgical situation can be challenging. Goal of this study was to identify the critical threshold of mal-angulation of the osteotomy plane and of femoral rotation that leads to a relevant deviation of the postoperative mechanical leg axis using a computer simulation approach. Methods Three-dimensional (3D) surface models of the lower extremity of two patients (Model 1: 42° femoral antetorsion; Model 2: 6° femoral retrotorsion) were generated from computed tomography data. First, baseline subtrochanteric and supracondylar rotational osteotomies, perpendicular to the femoral mechanical axis were simulated. Afterwards, mal-angulated osteotomies in sagittal and frontal plane followed by different degrees of rotation were simulated and frontal mechanical axis was analyzed. Results 400 mal-angulated osteotomies have been simulated. Mal-angulation of ±30° with 30° rotation showed maximum deviation from preoperative mechanical axis in subtrochanteric osteotomies (4.0° ± 0.4°) and in supracondylar osteotomies (12.4° ± 0.8°). Minimal mal-angulation of 15° in sagittal plane in subtrochanteric osteotomies and mal-angulation of 10° in sagittal plane in supracondylar osteotomies altered the mechanical axis by > 2°. Mal-angulation in sagittal plane showed higher deviations of the mechanical axis (up to 12.4° ± 0.8°), than in frontal plane mal-angulation (up to 4.0° ± 1.9°). Conclusion A femoral rotational osteotomy, perpendicular to the femoral mechanical axis, has no considerable influence on the mechanical leg axis. However, mal-angulation of femoral rotational osteotomies showed relevant changes of the mechanical leg axis. In supracondylar respectively subtrochanteric procedures, mal-angulation of only 10° in combination with already 15° of femoral rotation respectively mal-angulation of 15° in combination with 30° of femoral rotation, can lead to a relevant postoperative mechanical leg axis deviation of more than 2°, wherefore these patients probably would benefit from the use of navigation aids.
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Affiliation(s)
- Lukas Jud
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland.
| | - Lazaros Vlachopoulos
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Thomas V Häller
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Stefan Rahm
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
| | - Patrick O Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008, Zürich, Switzerland
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Fischer T, Stern C, Fritz B, Zingg PO, Pfirrmann CWA, Sutter R. Impact of stem design and cementation on postoperative femoral antetorsion in 227 patients with total hip arthroplasty (THA). Skeletal Radiol 2020; 49:2001-2009. [PMID: 32588096 PMCID: PMC7652799 DOI: 10.1007/s00256-020-03483-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In total hip arthroplasty (THA), surgeons attempt to achieve a physiological antetorsion. However, postoperative antetorsion of the femoral stem is known to show large variabilities. The purpose of this study was to assess whether postoperative antetorsion is influenced by stem design or cementation. MATERIALS AND METHODS This retrospective study included 227 patients with a hip prosthesis with five different stem designs (S1: short curved, S2 and S3: standard straight, S4: standard straight collared, S5: cemented straight), who had metal suppressed 1.5T-MRI of the hip between February 2015 and October 2019. Measurement of femoral antetorsion was done independently by two fellowship-trained radiologists on axial images by measuring the angle between the long axis of the femoral neck and the posterior condylar tangent of the knee. Measured angles in the different groups were compared using the t test for independent samples. RESULTS The cementless collared stem S4 showed the highest antetorsion with 18.1° (± 10.5°; range -10°-45°), which was significantly higher than the antetorsion of the collarless S3 with 13.3° (± 8.4°; - 4°-29°) and the cemented S5 with 12.7° (± 7.7°; - 3°-27°) with p = 0.012 and p = 0.007, respectively. S1 and S2 showed an antetorsion of 14.8° (± 10.0°; 1°-37°) and 14.1° (± 12.2°; - 20°-41°). The torsional variability of the cementless stems (S1-4) was significantly higher compared with that of the cemented S5 with a combined standard deviation of 10.5° and 7.7° (p = 0.019). CONCLUSION Prosthesis design impacts the postoperative femoral antetorsion, with the cementless collared stem showing the highest antetorsion. Cemented stems demonstrated significantly lower variability, suggesting the lowest rate of inadvertent malrotation.
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Affiliation(s)
- Tim Fischer
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Benjamin Fritz
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Patrick O. Zingg
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Christian W. A. Pfirrmann
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
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50
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Filli L, Jungmann PM, Zingg PO, Rüdiger HA, Galley J, Sutter R, Pfirrmann CWA. MRI with state-of-the-art metal artifact reduction after total hip arthroplasty: periprosthetic findings in asymptomatic and symptomatic patients. Eur Radiol 2019; 30:2241-2252. [PMID: 31863147 DOI: 10.1007/s00330-019-06554-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/07/2019] [Accepted: 10/29/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To assess the spectrum of periprosthetic MRI findings after primary total hip arthroplasty (THA). METHODS This multi-center cohort study analyzed 31 asymptomatic patients (65.7 ± 12.7 years) and 27 symptomatic patients (62.3 ± 11.9 years) between 6 months and 2 years after THA. 1.5-T MRI was performed using Compressed Sensing SEMAC and high-bandwidth sequences. Femoral stem and acetabular cup were assessed for bone marrow edema, osteolysis, and periosteal reaction in Gruen zones and DeLee and Charnley zones. Student t test and Fisher's exact test were performed. RESULTS The asymptomatic and symptomatic groups showed different patterns of imaging findings. Bone marrow edema was seen in 19/31 (61.3%) asymptomatic and 22/27 (81.5%) symptomatic patients, most commonly in Gruen zones 1, 7, and 8 (p ≥ 0.18). Osteolysis occurred in 14/31 (45.2%) asymptomatic and 14/27 (51.9%) symptomatic patients and was significantly more common in Gruen zone 7 in the symptomatic group (8/27 (29.6%)) compared to the asymptomatic group (2/31 (6.5%)) (p = 0.03). Periosteal reaction was present in 4/31 asymptomatic (12.9%) and 9/27 symptomatic patients (33.3%) and more common in Gruen zones 5 and 6 in the symptomatic group (p = 0.04 and 0.02, respectively). In the acetabulum, bone marrow edema pattern was encountered in 3/27 (11.1%) symptomatic patients but not in asymptomatic patients (p ≥ 0.21). Patient management was altered in 8/27 (29.6%) patients based on MRI findings. CONCLUSIONS Periprosthetic bone marrow edema is common after THA both in asymptomatic and symptomatic patients. Osteolysis and periosteal reaction are more frequent in symptomatic patients. MRI findings led to altered patient management in 29.6% of patients. KEY POINTS • Bone marrow edema pattern was frequent in both asymptomatic and symptomatic patients after THA, particularly around the proximal femoral stem in Gruen zones 1, 7, and 8. • Osteolysis was significantly more frequent in symptomatic patients in Gruen zone 7. • Periosteal reaction occurred more frequently in symptomatic patients in Gruen zones 5 and 6.
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