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  • Original ArticleMarch 31, 2023

    345 80

    Surgical Excision for Refractory Ischiogluteal Bursitis: A Consecutive Case Series of 21 Patients

    Sun-Ho Lee, MD, PhD, Won-Young Jang, MD, Min-Su Lee, MD, Taek-Rim Yoon, MD, PhD, Kyung-Soon Park, MD, PhD

    Hip Pelvis 2023; 35(1): 24-31
    Abstract
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    Purpose: A response to conservative treatment is usually obtained in cases of ischiogluteal bursitis. However, the time required to achieve relief of symptoms can vary from days to weeks, and there is a high recurrence rate, thus invasive treatment in addition to conservative treatment can occasionally be effective. Therefore, the aim of this study was to examine surgical excision in cases of refractory ischiogluteal bursitis and to evaluate patients’ progression and outcome.
    Materials and Methods: A review of 21 patients who underwent surgical excision for treatment of ischiogluteal bursitis between February 2009 and July 2020 was conducted. Of these patients, seven patients were male, and 14 patients were female. Injection of steroid and local anesthetic into the ischial bursa was administered at outpatient clinics in all patients, who and they were refractory to conservative treatment, including aspiration and prescription drugs. Therefore, surgery was considered necessary. Excisions were performed by two orthopedic specialists using a direct vertical incision on the ischial area. A review of each patient was performed after excision, and quantification of the outcomes recorded using clinical scoring systems was performed.
    Results: The results of radiologic evaluation showed that the mean lesion size was 6.2 cm×4.5 cm×3.6 cm. The average disease course after excision was 21.6 days (range, 15-48 days). Measurement of clinical scores, including the visual analog scale and Harris hip scores, was performed during periodic visits, with scores of 0.7 (range, 0-2) and 98.1 (range, 96-100) at one postoperative month, respectively.
    Conclusion: Surgical excision, with an expectation of favorable results, could be considered for treatment of ischiogluteal bursitis that is refractory to therapeutic injections, aspirations, and medical prescriptions, particularly in moderate-to-severe cases.

  • Original ArticleDecember 1, 2024

    224 78

    Difference of Neck Shortening in Femoral Neck Fracture between Femoral Neck System and Multiple Cannulated Cancellous Screws: Single Center, Prospective Randomized Controlled Trial

    Saurabh Gupta, MS , Abhay Elhence, MS , Sumit Banerjee, MS , Sandeep Yadav, MS , Prabodh Kantiwal, MS , Rajesh Kumar Rajnish, MS , Pushpinder Khera, MD* , Rajesh Malhotra, MS†

    Hip Pelvis 2024; 36(4): 310-319
    Abstract
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    Purpose: Fracture union after osteosynthesis of a fracture neck femur (FNF) occurs by compression of the fracture ends and potential neck shortening. Selection of an implant for fixation of a femoral fracture of the neck can be challenging when making management decisions. Femoral neck shortening after internal fixation of FNFs using a femoral neck system (FNS) or multiple cannulated cancellous screws (MCS) was compared.
    Materials and Methods: This prospective interventional single-blinded randomized controlled trial was conducted at a university teaching hospital. Sixty patients undergoing internal fixation for management of sub-capital or trans-cervical FNFs were randomized and assigned, to one of the two groups—the test group (FNS group) and the control group (MCS group). Primary outcome was determined by measuring the difference in 1-year shortening of the femoral neck on radiographs between FNS and MCS. The secondary objective was to determine the correlation between neck shortening with patient reported outcome measures (PROMs) at the end of the final follow-up.
    Results: At the final follow-up, shortening of the femoral neck was 3.77±1.87 mm in the FNS group, significantly lower compared with the MCS group, 6.53±1.59 mm.
    Conclusion: Significantly less shortening of the femoral neck was observed in the FNS group compared with the MCS group. No statistically significant difference in PROMs was observed at 1-year follow-up. The findings of the study suggest that FNS can be regarded as a suitable alternative for internal fixation in young adults (<60 years) with trans-cervical and subcapital FNFs.

  • Original ArticleMarch 31, 2023

    263 78

    Functional Outcome after Reimplantation in Patients Treated with and without an Antibiotic-Loaded Cement Spacers for Hip Prosthetic Joint Infections

    Michele Fiore, MD, Claudia Rondinella, MD, Azzurra Paolucci, MD, Lorenzo Morante, MD, Massimiliano De Paolis, MD , Andrea Sambri, MD, PhD

    Hip Pelvis 2023; 35(1): 32-39
    Abstract
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    Purpose: A staged revision with placement of a temporary antibiotic-loaded cement spacer after removal of the implant is the “gold standard” for treatment of chronic prosthetic joint infection (PJI). It enables local delivery of antibiotics, maintenance of limb-length and mobility, easier reimplantation. However, bacterial colonization of spacers and mechanical complications can also occur. The aim of this study is to evaluate functional results and infection control in two-stage treatment of total hip arthroplasty (THA) PJI with and without a spacer.
    Materials and Methods: A retrospective review of 64 consecutive patients was conducted: 34 underwent twostage revision using a cement spacer (group A), 30 underwent two-stage revision without a spacer (group B). At the final follow-up, functional evaluation of patients with a THA in site, without PJI recurrence, was performed using the Harris hip score (HHS). Measurement of limb-length and off-set discrepancies was performed using anteroposterior pelvic X-rays.
    Results: Most patients in group B were older with more comorbidities preoperatively. Thirty-three patients (97.1%) in group A underwent THA reimplantation versus 22 patients (73.3%) in group B (P<0.001). No significant differences in limb-length and off-set were observed. The results of functional evaluation performed during the final follow-up (mean, 41 months) showed better function in patients in group A (mean HHS, 76.3 vs. 55.9; P<0.001).
    Conclusion: The use of antibiotic-loaded cement spacer seems superior in terms of functional outcomes and reimplantation rate. Resection arthroplasty might be reserved as a first-stage procedure in patients who are unfit, who might benefit from a definitive procedure.

  • Original ArticleDecember 1, 2024

    238 76

    Hemiarthroplasty for Hip Fracture in Down Syndrome: A Retrospective Series of Five Cases

    Ahmed Nageeb Mahmoud, MD, MS, PhD*,† , John Paul Prodoehl, MD* , Maria F. Echeverry-Martinez, MD* , Daniel S. Horwitz, MD*

    Hip Pelvis 2024; 36(4): 281-289
    Abstract
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    Purpose: There is limited evidence regarding the outcomes of hip hemiarthroplasty (HA) following trauma in individuals living with Down syndrome (DS). This study aims to summarize the outcomes of hip HA in a series of individuals living with DS following femoral neck fractures.
    Materials and Methods: This retrospective study includes five cases of hip HA in four individuals with DS and displaced femoral neck fractures. Subjects (four males) had a mean age of 49.3 years (range, 26.1-59.7 years) at the time of surgery. All subjects presented with hip pain, loss of weight-bearing ability, and decreased activity level as reported by the subject caregivers. In all cases, the precise time of injury was not known.
    Results: After a mean follow-up of 15.2 months, all subjects had returned to the pre-injury activity level without any recorded complications. One individual died 32 months after surgery for unrelated causes; the remaining subjects are alive and ambulating without pain at a mean of 24.2 months since the surgery.
    Conclusion: When treating femoral neck fractures in those living with DS, careful history taking should be performed as regards the timing of trauma and the individual’s functional status. Hip HA seems a viable treatment option for those living with DS if a proper surgical procedure is utilized.

  • Case ReportJune 30, 2023

    276 74

    Stenotrophomonas maltophilia Periprosthetic Joint Infection after Hip Revision Arthroplasty

    Valentino Latallade, MD , Carlos Lucero, MD, Pablo Slullitel, MD, Martin Buttaro, MD

    Hip Pelvis 2023; 35(2): 142-146
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    Stenotrophomonas maltophilia, a well-established opportunistic bacterium, primarily impacts healthcare settings. Infection of the musculoskeletal system with this bacterium is rare. We report on the first known case of hip periprosthetic joint infection (PJI) caused by S. maltophilia. The potential for development of a PJI caused by this pathogen should be considered by orthopaedic surgeons, particularly in patients with multiple severe comorbidities.

  • EditorialDecember 1, 2024

    182 65
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  • Original ArticleMarch 31, 2023

    290 64

    Clinical and Functional Outcomes of the Exeter V40 Short Stem in Primary and Revision Arthroplasty: Does the Indication Affect Outcomes in the Short Term?

    Nemandra Amir Sandiford, FRCS (Tr/Orth), Scott M. Bolam, MBChB, Irrum Afzal, MSc* , Sarkhell Radha, FRCS (Tr/Orth)*

    Hip Pelvis 2023; 35(1): 40-46
    Abstract
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    Purpose: A variety of short Exeter stems designed specifically for use in performance of total hip arthroplasty (THA) in primary and revision settings have recently been introduced. Some have been used ‘off label’ for hip reconstruction. The aim of this study is to report clinical and radiological results from the Exeter V40 125 mm stem in performance of primary THA and revision THA.
    Materials and Methods: This study had a retrospective design. Insertion of 58 (24 primary, 34 revision) Exeter V40 125 mm stems was performed between 2015 and 2017. The minimum follow-up period was two years. Assessment of the Oxford hip score (OHS), EuroQol-5 Dimension (EQ-5D), and radiological follow-up was performed at one and two years.
    Results: In the primary group, the preoperative, mean OHS was 13.29. The mean OHS was 32.86 and 23.39 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were at 0.14, 0.59, and 0.35, preoperatively, at one-year follow-up and two-year follow-up, respectively. In the revision group, the mean preoperative OHS was 19.41. The mean OHS was 30.55 and 26.05 at one-year and two-year post-surgery, respectively. The mean EQ-5D-3L scores were 0.33, 0.61, and 0.48 preoperatively, at one-year follow-up and two-year follow- up, respectively. No progressive or new radiolucent lines were observed around any stem at the time of the final follow-up in all patients in both groups.
    Conclusion: Encouraging results regarding use of Exeter V40 125 mm stems have been reported up to two years following surgery in primary and revision THA settings.

  • Original ArticleDecember 1, 2024

    195 58

    Greater Trochanter Tip as an Anatomical Reference to Minimize Leg Length Discrepancy following Hip Arthroplasty

    John Christian Parsaoran Butarbutar, MD, PhD*,† , Gian Ivander, MD*,† , Albert Riantho, MD*,† , Kevin Fidiasrianto, MD*,† , Joshua Edward, MD*,† , Earlene Tasya, MD*,†

    Hip Pelvis 2024; 36(4): 302-309
    Abstract
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    Purpose: The objective of the current study is to introduce a proposed method and evaluate its efficacy using the greater trochanter (GT) tip rather than the lesser trochanter (LT) as an anatomical landmark to reduce leg length discrepancy (LLD) during performance of hip arthroplasty.
    Materials and Methods: Thirty-two patients who underwent hip arthroplasty were divided according to the GT group (n=17) and the LT control group (n=11); four patients were excluded. LLD was determined by assessing the vertical lengths parallel to the line connecting the lower margin of the teardrop to the most prominent part of the LT on a standing anteroposterior pelvic X-ray taken 30 days after the procedure. The mean and median LLD of the two groups were compared. Analysis of planning for femoral stem depth insertion and postoperative results was also performed.
    Results: No significant differences in characteristics including age, sex, or body mass index were observed between the two groups. However, the type of arthroplasty differed significantly between groups (P=0.016). The mean postoperative LLD was significantly smaller in the GT group compared with the control group (P=0.004). The results of linear regression of femoral stem depth showed a significant association between intraoperative planning and postoperative measurement (t=2.705, r2=0.672, P=0.016).
    Conclusion: Preoperative measurement in determining femoral stem depth insertion using the GT tip as an anatomical reference can effectively minimize LLD in patients who underwent hip arthroplasty.

  • Case ReportDecember 1, 2024

    178 57
    Abstract
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    The fully porous structure of the Lübeck prosthesis is designed to closely resemble cancellous bone. Several studies have reported ‘good’ to ‘excellent’ mid- to long-term results for use of the Lübeck, but stem fractures have been reported as a complication. We report on the case of an 85-year-old patient who underwent total hip arthroplasty (THA) using the Lübeck more than 25 years ago who underwent revision surgery for management of two periprosthetic femoral fractures and a stem fracture. A subtrochanteric fracture and a fracture of the stem were observed on radiographs, and a radiolucent line was observed in the proximal portion of the stem and a well-fixed distal portion was observed. Revision THA using a proximal femoral replacement stem and resection of the proximal femur has been proven as an effective procedure for treatment of an elderly patient with a fractured Lübeck stem with a well-fixed distal stem.
H&P
Vol.36 No.4 Dec 01, 2024, pp. 231~325
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