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S-51 Traumatic Dislocation and Fracture Dislocation of Hip: A Retrospective Study of 209 Cases
S50
Oral and Poster Presentations / Journal of Biomechanics 43S1 (2010) S23–S74
both dependable and easily reproducible. However we were unable to demonstrate if one method of application was superior to the other. We plan to further investigate this with a greater number of volunteers. We believe this sort of study is of benefit as if we can show that one technique of applying a C-spine collar is safer and more easily learnt than another, and it may help to prevent iatrogenic spinal cord injuries in future. S-51 Traumatic Dislocation and Fracture Dislocation of Hip: A Retrospective Study of 209 Cases S. Kashyap. Indira Gandhi Medical College and Associated Hospitals, India The work reported in this paper describes 209 cases of traumatic dislocation and fracture dislocation of hip. Due to inclusion of all types of hip dislocations whether simple or associated with fracture of femoral head or acetabulum, Short Form of 36 (SF-36) scoring for general health status of patients makes the present study different from previously available studies. Traumatic hip dislocation has increased in incidence since last century due to increase in the number of high velocity motor vehicle accidents. The aim of our study was to assess the final outcome of simple hip dislocation, hip dislocation with associated femoral head fracture and fracture of acetabulum. The parameters used were Short Form (SF-36) scoring for general health status and Hip Scoring by Merle d’Aubigne. ´ All available records of patients with traumatic hip dislocation and fracture-dislocation admitted between the 1994 and 2006 were screened. A total of 209 cases could be recalled. 46 cases were of pure hip dislocation, 24 cases were with associated femural head fracture, 139 patients were with acetabulum fracture and dislocation. Evaluation of present status, Anteroposterior (AP) radiograph of pelvis, lateral view of involved hip joint was done. The reduction of femur head under the dome was assessed; displacement of femur head arc and acetabulum arc within 1–3 mm was graded as good, 3–6 mm as fair and >6 mm as Poor. CT (Computed Tomography) Scan (transaxial/3D) was performed in special cases and MRI (Magnetic Resonance Imaging) was performed in 9 cases to diagnose avascular necrosis (AVN). Statistical analysis was done using analysis of variables and Chi square test. The mean follow up period was 3.1 years. There were 177 male patients (84.69%). Associated injuries were found in 77 (36.84%) patients. Open reduction was done in 132 (62.68%) patients; the majority were with acetabulum fracture. Complications included Avascular Necrosis, Coxarthrosis, Sciatic Nerve Injury and heterotopic ossification. AVN was found in 6 (13.04%) patients with hip dislocation, 28 (20.14%) with associated fracture of acetabulum and 5/24 (20.83%) of fracture of femoral head. The reduction time was more than 6 hrs in all patients who had avascular necrosis of head of femur. AVN was seen on 9 out of 17 patients of fracture acetabulum with poor anatomical reduction. The average Physical component summary (PCS) score was 46.4 in 69.6% patients. Similarly the average Mental Component Summary (MCS) score was 46.8 in 68% patients. Both these scores of 46.4 and 46.8 were at par with age matched norms in normal population. Patients having PCS scores more than 55 also had hip score excellent or good. PCS score less than 35 was found in patients with AVN and in 33% of patients with associated injuries. Traumatic hip dislocation is an orthopaedic emergency. Delay in reduction more than 6 hours is associated with increased incidence of AVN. Patients with associated injuries have overall bad outcome. Patients having low hip score had low PCS and MCS score. Our study is unique as it evaluates and compares the outcome after dislocation hip using SF-36 scoring which has not been done before. The outcome has also been affected by quality of reduction as poor reduction has resulted in low scores.
S-52 Hip Resurfacing: Clinical Findings after Our First 486 Cases M. Ribas. University Hospital Dexeus, Spain Introduction: Improvements in metal on metal bearings and excellent clinical midterm results has been the arguments for increasing resurfacing total hip arthroplasty implantation. The aim of the study was to compare our results with hip resurfacing arthroplasty with current published results in standard hip arthroplasty. Material and Method: From July 2003 to December 2008, 486 resurfacing total hip were implanted in our institution (4 bilateral) in 450 patients, 384 males and 66 females, mean age of 46.6 years (16–69). 9 Birmingham Hip Resurfacing, 2 ASR hip resurfacing, 3 ADEPT hip resurfacing, 5 CORIN hip resurfacing, 22 Mitch arthroplasties and 409 Conserve plus design were implanted. In 454 cases a modified Kocher-Langenbeck posterior approach and in 32 cases Hueter’s anterior approach were carried out. Surgical time, intraoperative bleeding and collected blood in drains, components orientation in anteroposterior radiographies, registered complications, Merle d’Aubigne´ (MDA), WOMAC and Harris Hip Score (HHS) were assessed. Statistical analysis was performed by means of chi-squared test and non-parametric tests. Results: Mean surgical time was 1h50 (1h15 to 2h30 ), mean intraoperative bleeding 273.4 cc (210–360 cc), drained blood 224.2 cc (180–380 cc). Mean cervico-diaphyseal angle was 139.7° (130–147°) and acetabular inclination 43° (40–65°). There was an improvement in MDA score, improved from 12.9 preoperative (11–14) to 17.4 at latest follow-up (15–18) (p < 0.001), WOMAC score, from 46.2 (19–67) to 93.2 (79–100) (p < 0.001) and HHS score, from 52.3 (42–60) to 96.7 (89–98) (p < 0.001). Survivorship rate was 98.3% at 2 years. There were 4 femoral fractures, all during the first six months after surgery, which required conversion to a total hip arthroplasty. Other complications were: One thrombosis of femoral artery, 1 deep venous thrombosis, 1 deep infection that required 2-stage exchange, 4 transient femoral nerve injuries. Overall survivorship, considering endpoint as implant surgical revision for any reason, was 98.9%. Conclusions: Hip resurfacing arthroplasty provide excellent clinical results, comparable to uncemented total hip implants, although longer follow up studies are required to confirm these midterm results. For this reason we do think that hip resurfacing arthroplasty is an excellent option for hip osteoarthritis in young adults. S-53 Personal Experience with HA-Coated Total Hip Arthroplasty M. Villanueva. University Hospital Gregorio Mara˜ non, Spain Introduction: Over the last few years there has been a growing evidence to support the use of uncemented total hip prostheses even in patients with osteoporotic bone1 . Several designs HA coated have demonstrated results that are certainly as good as any published contemporary, cemented stem series, with survivorships over 95% at 15 years, even in patients younger than 55 years2–4 . In addition uncemented stems may also reduce fat embolism, thromboembolic disease, and particularly, reduced operative time without increasing the cost of the procedure5 . Methods: 350 uncemented arthroplasties were performed in our institution during the past 10 years with an HA coated stem HA. In none of these cases an HA coated cup was used. The diagnosis was osteoarthritis, mainly in the older group (55–78 years): 280 patients. In patients younger than 50 years the main diagnoses were congenital dislocations, dysplasia, sequelae of fracture, infection, Calve-Legg-Perthes disease, avascular necrosis or femoroacetabular impingment. In most cases we used an uncemented straight stem fully coated with hydroxyapatite (HA) (Corail, De Puy). In cases of severe dysplasia, previous femoral osteotomy or proximal deformity our first choice was a proximally
Oral and Poster Presentations / Journal of Biomechanics 43S1 (2010) S23–S74
both dependable and easily reproducible. However we were unable to demonstrate if one method of application was superior to the other. We plan to further investigate this with a greater number of volunteers. We believe this sort of study is of benefit as if we can show that one technique of applying a C-spine collar is safer and more easily learnt than another, and it may help to prevent iatrogenic spinal cord injuries in future. S-51 Traumatic Dislocation and Fracture Dislocation of Hip: A Retrospective Study of 209 Cases S. Kashyap. Indira Gandhi Medical College and Associated Hospitals, India The work reported in this paper describes 209 cases of traumatic dislocation and fracture dislocation of hip. Due to inclusion of all types of hip dislocations whether simple or associated with fracture of femoral head or acetabulum, Short Form of 36 (SF-36) scoring for general health status of patients makes the present study different from previously available studies. Traumatic hip dislocation has increased in incidence since last century due to increase in the number of high velocity motor vehicle accidents. The aim of our study was to assess the final outcome of simple hip dislocation, hip dislocation with associated femoral head fracture and fracture of acetabulum. The parameters used were Short Form (SF-36) scoring for general health status and Hip Scoring by Merle d’Aubigne. ´ All available records of patients with traumatic hip dislocation and fracture-dislocation admitted between the 1994 and 2006 were screened. A total of 209 cases could be recalled. 46 cases were of pure hip dislocation, 24 cases were with associated femural head fracture, 139 patients were with acetabulum fracture and dislocation. Evaluation of present status, Anteroposterior (AP) radiograph of pelvis, lateral view of involved hip joint was done. The reduction of femur head under the dome was assessed; displacement of femur head arc and acetabulum arc within 1–3 mm was graded as good, 3–6 mm as fair and >6 mm as Poor. CT (Computed Tomography) Scan (transaxial/3D) was performed in special cases and MRI (Magnetic Resonance Imaging) was performed in 9 cases to diagnose avascular necrosis (AVN). Statistical analysis was done using analysis of variables and Chi square test. The mean follow up period was 3.1 years. There were 177 male patients (84.69%). Associated injuries were found in 77 (36.84%) patients. Open reduction was done in 132 (62.68%) patients; the majority were with acetabulum fracture. Complications included Avascular Necrosis, Coxarthrosis, Sciatic Nerve Injury and heterotopic ossification. AVN was found in 6 (13.04%) patients with hip dislocation, 28 (20.14%) with associated fracture of acetabulum and 5/24 (20.83%) of fracture of femoral head. The reduction time was more than 6 hrs in all patients who had avascular necrosis of head of femur. AVN was seen on 9 out of 17 patients of fracture acetabulum with poor anatomical reduction. The average Physical component summary (PCS) score was 46.4 in 69.6% patients. Similarly the average Mental Component Summary (MCS) score was 46.8 in 68% patients. Both these scores of 46.4 and 46.8 were at par with age matched norms in normal population. Patients having PCS scores more than 55 also had hip score excellent or good. PCS score less than 35 was found in patients with AVN and in 33% of patients with associated injuries. Traumatic hip dislocation is an orthopaedic emergency. Delay in reduction more than 6 hours is associated with increased incidence of AVN. Patients with associated injuries have overall bad outcome. Patients having low hip score had low PCS and MCS score. Our study is unique as it evaluates and compares the outcome after dislocation hip using SF-36 scoring which has not been done before. The outcome has also been affected by quality of reduction as poor reduction has resulted in low scores.
S-52 Hip Resurfacing: Clinical Findings after Our First 486 Cases M. Ribas. University Hospital Dexeus, Spain Introduction: Improvements in metal on metal bearings and excellent clinical midterm results has been the arguments for increasing resurfacing total hip arthroplasty implantation. The aim of the study was to compare our results with hip resurfacing arthroplasty with current published results in standard hip arthroplasty. Material and Method: From July 2003 to December 2008, 486 resurfacing total hip were implanted in our institution (4 bilateral) in 450 patients, 384 males and 66 females, mean age of 46.6 years (16–69). 9 Birmingham Hip Resurfacing, 2 ASR hip resurfacing, 3 ADEPT hip resurfacing, 5 CORIN hip resurfacing, 22 Mitch arthroplasties and 409 Conserve plus design were implanted. In 454 cases a modified Kocher-Langenbeck posterior approach and in 32 cases Hueter’s anterior approach were carried out. Surgical time, intraoperative bleeding and collected blood in drains, components orientation in anteroposterior radiographies, registered complications, Merle d’Aubigne´ (MDA), WOMAC and Harris Hip Score (HHS) were assessed. Statistical analysis was performed by means of chi-squared test and non-parametric tests. Results: Mean surgical time was 1h50 (1h15 to 2h30 ), mean intraoperative bleeding 273.4 cc (210–360 cc), drained blood 224.2 cc (180–380 cc). Mean cervico-diaphyseal angle was 139.7° (130–147°) and acetabular inclination 43° (40–65°). There was an improvement in MDA score, improved from 12.9 preoperative (11–14) to 17.4 at latest follow-up (15–18) (p < 0.001), WOMAC score, from 46.2 (19–67) to 93.2 (79–100) (p < 0.001) and HHS score, from 52.3 (42–60) to 96.7 (89–98) (p < 0.001). Survivorship rate was 98.3% at 2 years. There were 4 femoral fractures, all during the first six months after surgery, which required conversion to a total hip arthroplasty. Other complications were: One thrombosis of femoral artery, 1 deep venous thrombosis, 1 deep infection that required 2-stage exchange, 4 transient femoral nerve injuries. Overall survivorship, considering endpoint as implant surgical revision for any reason, was 98.9%. Conclusions: Hip resurfacing arthroplasty provide excellent clinical results, comparable to uncemented total hip implants, although longer follow up studies are required to confirm these midterm results. For this reason we do think that hip resurfacing arthroplasty is an excellent option for hip osteoarthritis in young adults. S-53 Personal Experience with HA-Coated Total Hip Arthroplasty M. Villanueva. University Hospital Gregorio Mara˜ non, Spain Introduction: Over the last few years there has been a growing evidence to support the use of uncemented total hip prostheses even in patients with osteoporotic bone1 . Several designs HA coated have demonstrated results that are certainly as good as any published contemporary, cemented stem series, with survivorships over 95% at 15 years, even in patients younger than 55 years2–4 . In addition uncemented stems may also reduce fat embolism, thromboembolic disease, and particularly, reduced operative time without increasing the cost of the procedure5 . Methods: 350 uncemented arthroplasties were performed in our institution during the past 10 years with an HA coated stem HA. In none of these cases an HA coated cup was used. The diagnosis was osteoarthritis, mainly in the older group (55–78 years): 280 patients. In patients younger than 50 years the main diagnoses were congenital dislocations, dysplasia, sequelae of fracture, infection, Calve-Legg-Perthes disease, avascular necrosis or femoroacetabular impingment. In most cases we used an uncemented straight stem fully coated with hydroxyapatite (HA) (Corail, De Puy). In cases of severe dysplasia, previous femoral osteotomy or proximal deformity our first choice was a proximally