A Short Femoral Stem in Revision Total Hip Replacement: An Alternative Solution for Prosthetic Fracture: A Case Report.

CASE: A 65-year-old farmer re-presented 5 years after sustaining a midshaft prosthetic fracture of a previous long-stem revision hip replacement. He was treated with a proximal-loading short femoral stem, and did not require an extended trochanteric osteotomy for removal of the well-fixed distal implant. He was able to fully bear weight immediately postoperatively, and he remained pain-free without functional loss at the 42-month follow-up. CONCLUSION: This use of a modern short-stem prosthesis is a treatment option for a potentially complex prosthetic fracture in highly active patients, and it reduces intraoperative complexity.

Our early experience of the Corin Minihip prosthesis.

PURPOSE: Although there have been several varieties of short-stem hip prosthesis in the market, there have been no published clinical results of the Corin MiniHip (Corin, Cirencester, UK) to date. The aim of this study is to describe our early results and experience of this stem in a nondesigner, single-surgeon series; calculate 5-year survival with stem revision as an endpoint; evaluate complications and early revisions; and assess radiolucency and stem subsidence at the latest follow-up review. METHODS: Over a 5-year period, 275 MiniHip were implanted in 239 patients. The mean age of the patients was 63 years (range 20-84); mean follow-up was 37 months (range 12-72 months). RESULTS: The mean Harris Hip Score and Oxford Hip Score improved significantly to 87 (range 49-100) and 41 (range 32-48) at the final follow-up (p = 0.038; p = 0.017). There were 9 intraoperative calcar fractures (3%) of which only 1 required cerlage wiring. 10 patients died in our series and none were lost to follow-up. 2 patients had their stem revised for failure of fixation (secondary to possible undersizing) and sink. The risk of revision was 0.73% at 5 years. The Kaplan Meier estimate of survivorship of cumulative failure gave an implant survival rate of 99.3% (95% confidence interval [CI], 27.0-100) at 5 years for revision for any reason as the endpoint. CONCLUSIONS: This novel, short-stem prosthesis has shown good survival in the short term, similar to other short-stem prostheses currently available. We describe the largest series in the literature of this prosthesis.

Sciatic nerve palsy--a complication of posterior approach using enhanced soft tissue repair for total hip arthroplasty.

Sciatic nerve palsy is a rare but well recognised complication of total hip replacement. There are a variety of potential causes of sciatic nerve palsy and its prevalence with different approaches has been mentioned in the literature.(1-5) The posterolateral or 'Southern' approach with some form of enhanced soft tissue repair is a commonly used approach for primary total hip arthroplasty. However, the sciatic nerve is recognised to be in close proximity to the surgical field. We report a case of sciatic nerve palsy after this approach as a result of a surgical suture used for soft tissue repair.

Achieving the required medial offset and limb length in total hip arthroplasty.

The magnitude of the medial offset and limb length discrepancy after a total hip arthroplasty (THA) significantly affects the biomechanics of the hip. If both of these components are not properly restored, the rate of dislocation may increase. In addition limb length inequality can be a cause for legal problems. We have used a method of intraoperative assessment to restore both the length and the medial offset, and assessed this by comparing the medial offset and leg length in the pre- and post-operative radiographs in 39 consecutive THAs. The median medial offset was 93.9% (range: 85 to 100) preoperatively and 94.2% (range: 85 to 110) postoperatively, compared with the unaffected contralateral side. The median limb length discrepancy was improved from a preoperative -4.84 mm (range: 0 to -30) to a postoperative -0.06 mm (range: -9 to +16). In conclusion, this technique is a simple, accurate and reliable way of restoring the medial femoral offset and correcting the limb length inequality.