Sanket R. Diwanji

Two-stage reconstruction of infected hip joints.

Two-stage reconstruction using an antibiotic-loaded cement spacer is the preferred treatment of deep infection after total hip arthroplasty (THA). We evaluated the results of this technique for the treatment of primary hip infections. Nine consecutive patients with infected hip joints were treated using this technique. The average duration of follow-up was 42 months. Debridement and insertion of an antibiotic-loaded cement spacer was performed in the first stage. After eradication of infection, it was converted to THA in the second stage. Of the 9 hips, 8 were successfully converted to THA after an average of 23 weeks. One patient required spacer reinsertion, and another experienced reinfection after THA. Average Harris hip score improved from 38.37 before surgery to 57.62 between the 2 stages to 97.83 at final follow-up. Two-stage reconstruction using an antibiotic-loaded cement spacer was found to give satisfactory results for the treatment of hip infections with various etiologies.

Clinical Results of Conversion Total Hip Arthroplasty After Failed Bipolar Hemiarthroplasty

Total hip arthroplasty (THA) has been the most common surgery performed for complications of bipolar arthroplasty. We wanted to evaluate functional results and complications after conversion of bipolar hemiarthroplasty to THA in 25 patients followed for an average of 7.2 years. Indications for conversion included acetabular erosion with well-fixed femoral stem in 13 patients, acetabular erosion with femoral loosening in 8 patients, and periprosthetic fracture in 4 patients. The average Harris Hip Score improved from 41 (34 to 67) before conversion to 85 (65 to 95) at final follow-up. The average Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score improved from 81 (41 to 96) before conversion to 17 (8 to 36) at final follow-up. Pain component of WOMAC improved from an average of 15 (7 to 20) to 4 (0 to 11). The stiffness component of WOMAC improved from 6 (2-8) to 30 (0-4) and the function component improved from 59 (36-68) to 17 (8-36). The complications included 2 recurrent dislocations, 2 dislocations, 1 acetabular loosening, and 1 trochanteric nonunion. One patient required revision of acetabular component. The conversion THA after symptomatic bipolar arthroplasty can offer reliable pain relief and functional improvement. The perioperative complications approximate those of revision THAs.

Clinical results of multiple fibrous band release for the external snapping hip

BackgroundExternal snapping hip is caused by snapping of the thickened iliotibial band or the gluteus maximus over the greater trochanter. We retrospectively reviewed results of the release of multiple fibrous bands of the iliotibial band or gluteus maximus for treatment of external snapping hip in 44 patients.MethodsWe wanted to evaluate the functional results of this technique in terms of resolution of symptoms, patient satisfaction, and complications. A snapping hip questionnaire was designed for the evaluation, and the results were evaluated at an average 62 months after surgery.ResultsAll the patients had resolution of their symptoms after surgery and were satisfied with the treatment. Recurrence of snapping was reported in five patients, but they did not find it severe enough to require a second surgery. Ten patients reported some limp or weakness, and four patients had seroma formation, requiring reinsertion of a drainage tube.ConclusionsWe recommend release of multiple fibrous bands of the iliotibial band and gluteus maximus muscle for treatment of external snapping hip, as it has a low rate of recurrence and a high rate of patient satisfaction.

Displaced Stress Fracture of the Femoral Neck Treated by Valgus Subtrochanteric Osteotomy 2 Case Studies

it was once thought to be. Since it was first reported in 1936, several authors have subsequently reported series of femoral neck stress fractures. Stress fracture of the femoral neck is commonly seen in military recruits and long-distance marathon runners. In most instances, these fractures are nondisplaced, respond well to conservative treatment, and are associated with minimal morbidity. Moreover, most authors have concluded that these fractures should be detected early before displacement occurs, because displaced SFFN carries a high risk of complications such as nonunion, delayed union, and avascular necrosis of the femoral head. Treatment outcome depends on reduction alignment, time between fracture occurrence and treatment, and the type of implant used. Various techniques, including muscle pedicle bone grafting and fibula grafting, have been described for the treatment of displaced SFFN and its complications. However, to the best of our knowledge, the use of subtrochanteric valgus osteotomy for the primary treatment of displaced SFFN has not been reported. Here, we describe 2 cases of displaced SFFN with delayed presentation that were successfully treated by subtrochanteric valgus osteotomy. CASE 1

Pigmented Villonodular Synovitis of the Hip Presenting as a Buttock Mass Treated by Total Hip Arthroplasty

Pigmented villonodular synovitis (PVNS) of the hip is a relatively uncommon benign but locally aggressive disease that should be considered in younger patients presenting with monoarticular joint symptoms. Pigmented villonodular synovitis begins in and usually remains confined within a synovium-lined joint, but rarely, it may extend beyond the joint capsule and present as a soft tissue mass. The authors report a previously unrecognized presentation of PVNS of the hip in a 36-year-old man, who presented with a buttock mass arising from the right hip joint. The patient was treated by synovectomy and total hip arthroplasty.

Total Hip Arthroplasty for Treatment of Fused Hip With 90° Flexion Deformity

Conversion of a fused hip to total hip arthroplasty is a challenging procedure. The results depend on the degree of the change that occurs in the muscles and soft tissues at the hip from long immobilization, and considerable postoperative rehabilitation is necessary. Complications such as nerve injury, dislocation, infection and heterotopic ossification are common. Most of the authors recommended trochanteric osteotomy for better exposure. We are reporting a case of conversion total hip arthroplasty performed for a hip fused in 90 degrees of flexion. Surgical technique is described in detail and pertinent literature is reviewed.

BILATERAL SIMULTANEOUS TWO-INCISION MINIMALLY INVASIVE TOTAL HIP ARTHROPLASTY

BackgroundThis study aimed to assess the feasibility of bilateral simultaneous minimally invasive two-incision total hip arthroplasty in terms of clinical and radiological outcomes, complications, and patient satisfaction.MethodsA total of 62 patients, ages 24–69 years, were operated on with bilateral simultaneous minimally invasive total hip arthroplasty using a modified two-incision technique, after which they were followed for an average 41 months. The acetabular component was inserted through part of the Watson-Jones approach, and a femoral component was inserted through a space between the gluteus medius and piriformis tendon.ResultsThe mean duration of surgery was 180.4 min, and the mean perioperative blood loss was 1513.2 ml. There were no intraoperative complications. Postoperative periprosthetic fracture occurred in two patients and delayed infection in one patient. The average Harris Hip Score improved from 41.8 to 95.3. The WOMAC score improved from an average of 66.2 to 5.0. The average lateral opening angle of the acetabulum was 40°, and the angle of anteversion was 12°. All the femoral components were implanted in neutral to 5° valgus position.ConclusionsBilateral simultaneous minimally invasive total hip arthroplasty using a modified two-incision technique gave satisfactory clinical, radiological, and functional results. Efforts should be made to prevent perioperative periprosthetic fractures.

Hemorrhagic Iliopsoas Bursitis Complicating Well-Functioning Ceramic-on-Ceramic Total Hip Arthroplasty

Iliopsoas bursitis has been increasingly recognized as a complication of total hip arthroplasty and is usually associated with polyethylene wear. Here, the authors report a case of hemorrhagic iliopsoas bursitis complicating an otherwise well-functioning ceramic-on-ceramic arthroplasty performed by minimal invasive modified 2-incision technique. The bursitis in turn resulted in femoral nerve palsy and femoral vein compression. In this report, there was no evidence to support that the bursitis was due to an inflammatory response to ceramic wear particles or any other wear particles originating from the total hip arthroplasty.

Minimally Invasive Two-Incision Total Hip Replacement using large Diameter Ceramic-on-Ceramic Articulation

Background Our experience with the minimally invasive (MI) two-incision technique over the last 4 years has shown that total hip arthroplasty (THA) can be performed safely and effectively in properly selected patients. Total hips with larger-diameter femoral heads are more resistant to dislocation. The purpose of the present study was to evaluate the short-term results of a minimally invasive two-incision THA Using Large Diameter Ceramic-on-Ceramic Articulation.