Direction of hip arthroplasty dislocation in patients with femoral neck fractures

Enocson, Anders; Lapidus, Gunilla; Törnkvist, Hans; Tidermark, Jan; Lapidus, Lasse J

doi:10.1007/s00264-009-0943-6

Cited by 15 publications

(16 citation statements)

References 35 publications

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“…Dislocation rates may be influenced by joint capsule reconstruction [10] and implant positioning [13]. Increased dislocation rates have also been found in patients after prolonged operative time [14].…”

Section: Dorsal Vs Transgluteal Approach: From the Frying Pan Into Thmentioning

confidence: 99%

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Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

Biber

Brem

Singler³

et al. 2012

International Orthopaedics (SICOT)

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Purpose Hemiarthroplasty (HA) is an established treatment for femoral neck fractures of the elderly. Several surgical approaches are currently used including dorsal and transgluteal. It is still unclear whether one approach may be advantageous. We compared early complication rates after dorsal and transgluteal approaches. Methods We retrospectively analysed a cohort including 704 consecutive patients who received HA for femoral neck fracture; 212 male and 492 female patients were included, and the mean age was 80.4 years (SD 9.8 years). In 487 patients a dorsal and in 217 a transgluteal approach was chosen. In all patients an Excia® stem with selfcentring bipolar head manufactured by Aesculap (Tuttlingen, Germany) was used. We evaluated early postoperative complications including dislocation, infection, haematoma, seroma and perioperative fracture. Complication rates after dorsal and transgluteal approaches were calculated and compared by the chi-square test.Results After a dorsal approach 10.5 % [confidence interval (CI) 7.7-13.2 %] of the patients suffered one or more early complications. Following a transgluteal approach this proportion was 9.7 % (CI 5.7-13.6 %), which was not significantly different (p00.75). The predominant complication after a dorsal approach was dislocation (3.9 %; CI 2.2-5.6 %). The dislocation rate after a transgluteal approach was significantly lower (0.5 %; CI 0-1.4 %). Postoperative haematoma however was seen after a transgluteal approach in 5.5 % (CI 2.5-8.6 %), which was significantly more frequent than after a dorsal approach (1.2 %; CI 0.2-2.2 %). The frequency of the other types of complications did not significantly differ. Conclusions The rate of early surgical complications after dorsal and transgluteal approaches is not significantly different. However, the dorsal approach predisposed to dislocation, whereas the transgluteal approach predisposed to haematoma.

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Section: Dorsal Vs Transgluteal Approach: From the Frying Pan Into Thmentioning

confidence: 99%

“…Following THA several studies showed a lower dislocation rate after the transgluteal approach compared to the dorsal approach [10][11][12][13][14]. Unfortunately most publications focus only on dislocation rate.…”

Section: Introductionmentioning

confidence: 99%

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

Biber

Brem

Singler³

et al. 2012

International Orthopaedics (SICOT)

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“…A basic prerequisite is exact alignment of stem and cup [1,3,7,11]. The malposition of one or both components can cause dislocation, impingement, wear and aseptic loosening [1-3, 7, 8].…”

Section: Introductionmentioning

confidence: 99%

The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty

Müller

Crucius

Perka

et al. 2010

International Orthopaedics (SICOT)

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Adequate stem alignment is essential for the success of Total Hip Arthroplasty (THA) to avoid dislocation and impingement. One factor that has not been sufficiently investigated so far is the stem tilting in the sagittal plane, which has an influence on the position of the centre of the femoral head and thus also on prosthesis torsion. We aimed to evaluate sagittal stem position using 3D-CTs in patients with THA and to develop a mathematical-geometrical model to simulate the functional correlation between sagittal stem tilting and the influence on functional anteversion. Thirty patients with THA underwent a CT-scan. By 3D-reconstruction of the CT-data, femoral-/prosthesis-axis, torsion and sagittal tilt were determined. In accordance with the position of the femoral and prosthesis axes, the rotatory (rAV) (surgically adjusted) and functional (depending on sagittal tilt) anteversion (fAV) was measured. A three dimentionalcoordinate transformation was also performed using the Euler-angles to derive a mathematical-geometrical correlation between sagittal stem tilting and corresponding influence on anteversion. The mean rAV was 8°(-11.6 -26°), the fAV 18°( 6.2 -37°), and the difference 10°(8.8 -18°). The mean degree of stem tilting was 5.2°(0.7 -9°) anterior towards the femoral axis. The individually measured parameters are reflected in the mathematical-geometrical model. Depending on the extent of the sagittal deviation, a clear influence on the torsion emerges. For example, a stem implanted at a 15°a nteverted angle with a sagittal tilt by two degrees towards anterior results in a fAV of 20°. A clear association between the sagittal stem alignment and the impact on the fAV was demonstrated. Hence, the rotatory anteversion intended by the surgeon may be functionally significantly different. This might pose an increased risk of dislocation or impingement. The sagittal tilt of the prosthesis should therefore be considered in the context of impingement and dislocation diagnosis. In this respect, we recommend a 3D-analysis of stem alignment.

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“…Related to the approach, different parts of the hip capsule and capsule ligaments were dissected and either left open or reconstructed, initiating an extensive discussion of the role of capsular reconstruction, where capsular reconstruction seems to be beneficial [ 7 ]. In addition, it was shown that the surgical approach predicts the dislocation direction of the hip prosthesis [ 41 ]. Thus, the whole hip capsule ligaments might be involved in reducing dislocation events.…”

Section: Discussionmentioning

confidence: 99%

The Stress-Strain Data of the Hip Capsule Ligaments Are Gender and Side Independent Suggesting a Smaller Contribution to Passive Stiffness

Pieroh

Schneider²,

Lingslebe³

et al. 2016

PLoS ONE

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BackgroundThe ligaments in coherence with the capsule of the hip joint are known to contribute to hip stability. Nevertheless, the contribution of the mechanical properties of the ligaments and gender- or side-specific differences are still not completely clear. To date, comparisons of the hip capsule ligaments to other tissues stabilizing the pelvis and hip joint, e.g. the iliotibial tract, were not performed.Materials & MethodsHip capsule ligaments were obtained from 17 human cadavers (9 females, 7 males, 13 left and 8 right sides, mean age 83.65 ± 10.54 years). 18 iliofemoral, 9 ischiofemoral and 17 pubofemoral ligaments were prepared. Uniaxial stress-strain properties were obtained from the load-deformation curves before the secant elastic modulus was computed. Strain, elastic modulus and cross sections were compared.ResultsStrain and elastic modulus revealed no significant differences between the iliofemoral (strain 129.8 ± 11.1%, elastic modulus 48.8 ± 21.4 N/mm2), ischiofemoral (strain 128.7 ± 13.7%, elastic modulus 37.5 ± 20.4 N/mm2) and pubofemoral (strain 133.2 ± 23.7%, elastic modulus 49.0 ± 32.1 N/mm2) ligaments. The iliofemoral ligament (53.5 ± 15.1 mm2) yielded a significantly higher cross section compared to the ischiofemoral (19.2 ± 13.2 mm2) and pubofemoral (15.2 ± 7.2 mm2) ligament. No significant gender- or side-specific differences were determined. A comparison to the published data on the iliotibial tract revealed lower elasticity and less variation in the ligaments of the hip joint.ConclusionComparison of the mechanical data of the hip joint ligaments indicates that their role may likely exceed a function as a mechanical stabilizer. Uniaxial testing of interwoven collagen fibers might lead to a misinterpretation of the mechanical properties of the hip capsule ligaments in the given setup, concealing its uniaxial properties. This underlines the need for a polyaxial test setup using fresh and non-embalmed tissues.

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Direction of hip arthroplasty dislocation in patients with femoral neck fractures

Cited by 15 publications

References 35 publications

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

Dorsal versus transgluteal approach for hip hemiarthroplasty: an analysis of early complications in seven hundred and four consecutive cases

The association between the sagittal femoral stem alignment and the resulting femoral head centre in total hip arthroplasty

The Stress-Strain Data of the Hip Capsule Ligaments Are Gender and Side Independent Suggesting a Smaller Contribution to Passive Stiffness

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