Feng-Chih Kuo

Outcomes of Mixed Femoral Fixation Technique Using Both Cement and Ingrowth in Revision Total Hip Arthroplasty: Minimum 2-Year Follow-up

The use of a modular femoral stem in revision total hip arthroplasty (THA) has been increasing recently. However, complications such as subsidence, dislocation and stem fracture are still noted, especially in hips with high grade femoral deficiency. We retrospectively studied a consecutive 41 hips (40 patients) that underwent revision THA with allograft reconstruction of the proximal femur in conjunction with hybrid fixation (proximally cemented and distally press-fit) of a modular femoral component. At a mean follow-up of 5.2 years (2 to 8 years), no hips sustained dislocation, subsidence or fracture of the stem in the follow-up period. We provided evidence that this technique may be a good alternative in the management of proximal femoral bone loss during revision THA.

No benefit on functional outcomes and dislocation rates by increasing head size to 36 mm in ceramic-on-ceramic total hip arthroplasty.

Background Ceramic-on-ceramic (COC) total hip arthroplasty (THA) has gained popularity since improvements in wear characteristics and longevity. Whether large ceramic femoral heads (≥36 mm) have increased postoperative range of motion (ROM) and a lower dislocation rate is not clear. This study aimed to compare functional outcomes and early complications between large-head (≥36 mm) and smaller-head (≤32 mm) COC prostheses with a minimum follow-up of 12 months. Methods A total of 95 consecutive uncemented COC THAs were performed in 90 patients between January 2012 and July 2013. Of these, 49 patients (smaller-head group) received third generation and 41 patients (large-head group) received fourth generation COC prostheses. Harris hip score (HHS), Western Ontario and McMaster Universities Arthritis index (WOMAC), and ROM of the hip pre- and post-operatively were compared, as well as the presence of early complications. Results Postoperative HHSs (88.4 vs. 89.3, p = 0.34) and WOMAC scores (12.0 vs. 11.0, p = 0.111) were not different between the groups. Postoperative flexion ROM was lower in the smaller-head group (98.8° vs. 106.1°, p < 0.001), but there were no differences in extension, abduction, adduction, internal rotation, and external rotation. One patient in each group reported a grinding noise. There was one dislocation (1.9%) in the smaller-head group, and none in the large-head group (p = 0.371). No infections or loosening of the components occurred. Conclusions Large-head COC articulation provided better flexion, but functional outcomes and early complications are similar to the smaller-head COC.

A 10-Year Follow-Up of Two-Incision and Modified Watson-Jones Total Hip Arthroplasty in Patients with Osteonecrosis of the Femoral Head

Long-term data and information indicating whether minimally invasive surgery (MIS) approaches are safe and effective with total hip arthroplasty (THA) are lacking. Between 2004 and 2006, 75 patients with alcohol-related osteonecrosis of the femoral head (ONFH) who underwent 75 THAs with the two-incision approach were studied. The medical records, radiographic parameters, and functional outcomes were collected prospectively. All data were compared with those for matched patients who underwent a modified Watson-Jones (WJ) approach. THA using the two-incision approach was associated with longer operation time, more blood loss, more lateral femoral cutaneous nerve injury, and more periprosthetic femoral fractures (p < 0.05 for all four) than the modified WJ approach. The Harris Hip Score (HHS) and Western Ontario and McMaster University Osteoarthritis Index (WOMAC) increased significantly from the period preoperatively to 6 weeks postoperatively and thereafter up to the last follow-up in both groups. However, there were no significant differences in terms of radiographic parameters and functional outcomes between the two groups throughout the study period. Both the two-incision and the modified WJ approach provided satisfactory results and survival rates at a mean follow-up of 10.8 years. A prospective, randomized, large-scale cohort study is still warranted for evidence-based recommendations.

AQUACEL® Ag Surgical Dressing Reduces Surgical Site Infection and Improves Patient Satisfaction in Minimally Invasive Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study

The use of modern surgical dressings to prevent wound complications and surgical site infection (SSI) after minimally invasive total knee arthroplasty (MIS-TKA) is lacking. In a prospective, randomized, controlled study, 240 patients were randomized to receive either AQUACEL Ag Surgical dressing (study group) or a standard dressing (control group) after MIS-TKA. The primary outcome was wound complication (SSI and blister). The secondary outcomes were wear time and number of dressing changes in the hospital and patient satisfaction (pain, comfort, and ease of use). In the intention-to-treat analysis, there was a significant reduction in the incidence of superficial SSI (0.8%, 95% CI∶ 0.00–2.48) in the study group compared to 8.3% (95% CI∶ 3.32–13.3) in the control group (p = 0.01). There were no differences in blister and deep/organ-space SSIs between the two groups. Multivariate analysis revealed that AQUACEL Ag Surgical dressing was an independent risk factor for reduction of SSI (odds ratio: 0.07, 95% CI: 0.01–0.58, p = 0.01). The study group had longer wear time (5.2 ± 0.7 versus 1.7 ± 0.4 days, p < 0.0001) and lower number of dressing changes (1.0 ± 0.2 versus 3.6 ± 1.3 times, p < 0.0001). Increased patient satisfaction (p < 0.0001) was also noted in the study group. AQUACEL Ag Surgical dressing is an ideal dressing to provide wound care efficacy, patient satisfaction, reduction of SSI, and cost-effectiveness following MIS-TKA.

Surgical Approach May Influence Survival of Large-Diameter Head Metal-on-Metal Total Hip Arthroplasty: A 6- to 10-Year Follow-Up Study

Large-diameter head (LDH) metal-on-metal (MoM) total hip arthroplasty (THA) has lost popularity because of metal allergy or ALTRs (adverse local tissue reactions) in the past decade. Whether the surgical approach may influence the survival of LDH-MoM-THA has not been reported. From 2006 to 2009, we performed 96 LDH-MoM-THAs on 80 patients using an in situ head-neck assembly technique through a modified Watson-Jones approach. With a mean follow-up of 8.4 years (range, 6.3–10.1 years), the implant survival rate was 100%. All patients were satisfied with the results and the Harris Hip Score improved from 52 points to 98 points. No ALTRs were found, but 17.7% of the 96 hips (17 adverse events) experienced adverse events related to the cup, including 5 cases of outlier cup malposition, 11 cases of inadequate cup seating, and 1 acetabular fracture. The tissue tension that was improved by a muscle-sparing approach might lessen the chance of microseparation or edge-loading that is taken as the major risk for early implant failure. Further investigation of whether these LDH-MoM-THAs would fail or not would require a longer follow-up or even retrieval analysis in the future.

Long-term outcome of two-incision total hip arthroplasty with intraoperative imageless navigation for cup placement: A concise followup, at ten to twelve years, of a previous report

Background: We previously reported at a minimum follow-up of one-year results of the use of imageless navigation for cup placement in primary two-incision total hip arthroplasties (THA). The purpose of the present report is to update that study and report the ten to twelve-year outcomes. Materials and methods: Twelve consecutive patients underwent minimally invasive two-incision (MIS-2) THA done by a single experienced surgeon between September 2003 and January 2005. A retrospective chart review was performed to investigate clinical assessment (the Harris hip score [HHS] and the Western Ontario and McMaster University Osteoarthritis Index [WOMAC] scale), radiographic analysis, the complications and survivorship. Results: At the latest follow-up evaluation, the HHS and WOMAC scale were 95.4 and 96.5 points respectively. There were no radiographic evidence of definite loosening. Injury to the lateral femoral cutaneous nerve occurred in 4 hips. There were no dislocation, no periprosthetic joint infection or fracture. The 10- year Kaplan-Meier analysis revealed 100% survival rate with revision for any reason as the end point. Conclusion: This study demonstrated that imageless navigation system for the two-incision THA give excellent long-term results.

Long term follow-up of transtrochanteric rotational osteotomy in patients with extensive and collapsed femoral head osteonecrosis

Background: Transtrochanteric rotational osteotomy (TRO) potentially can salvage hips with extensive and collapsed lesions of femoral head osteonecrosis (ONFH). However, the results varied greatly and few long term results were reported. Methods From 1998 to 2001, TRO had been done on 15 ONFH hips. The mean age of the patients was 42 years. All hips were associated with extensive lesions and in the early collapsed stage (ARCO staging system, IIIA less than 2 mm collapse in 10 hips and IIIB 2 to 4 mm collapse in 5 hips). Demographic data, Harris hip score, and radiological outcomes were reviewed. Results: Anterior rotational osteotomy was done in 11 hips and posterior rotational osteotomy was done in 4 hips. The index of necrosis was 39% in average (range, 12% to 68%). In the 15 hips with an average follow-up of 11 years, the Harris hip score improved from 39.1 to 76.2. Six hips were converted to total hip replacement in an average of 3.6 years. The overall survival rate for conversion to total hip replacement as the end point was 60%. The overall radiological success rate was 53.3% Conclusions: TRO is a worthy procedure to preserve extensive and collapsed hips with acceptable success rate. Technical difficulties while executing the surgery or converting to total hip replacement should be considered and discussed fully with the patients.