Efficacy of Anterior Quadratus Lumborum Block and Pain After Total Hip Arthroplasty: A Randomized Controlled Trial.

BACKGROUND: Anterior quadratus lumborum block (AQLB) is one of the compartment blocks and has recently attracted attention as a new method of analgesia for postoperative hip surgery analgesia. This study aimed to compare the analgesic efficacy of AQLB in patients undergoing primary total hip arthroplasty (THA). METHODS: There were 120 patients undergoing primary THA under general anesthesia randomly allocated to receive a femoral nerve block (FNB) or an AQLB. The primary outcome was total morphine consumption over the initial 24-hour postoperative period. Secondary outcomes included the pain score evaluation while at rest and during active and passive motion over the 2 days following surgery and the manual muscle testing of the quadriceps femoris. The numerical rating scale (NRS) score was used for evaluating the postoperative pain score. RESULTS: There were no significant differences between the 2 groups concerning morphine consumption within 24 hours after surgery (P = .72). The NRS score at rest and passive motion were similar at all-time points (P > .05). However, there was a statistically significant difference in pain reported during the active motion for the FNB group compared to the AQLB (P = .04). No significant differences were found between the 2 groups concerning muscle weakness incidence. CONCLUSION: Both AQLB and FNB demonstrated adequate efficacy for postoperative analgesia at rest in THA. However, based on our study, whether AQLB is inferior or noninferior to FNB as an analgesic method for THA was inconclusive.

Long term results of the Bicontact D stem in dysplastic osteoarthritis: a 10-15 year follow-up study.

PURPOSE: The purpose of the present study was to investigate the results of total hip arthroplasty (THA) using the Bicontact D stem with a minimum 10 year follow-up that focused on patients with developmental dysplasia of the hip (DDH). METHODS: One hundred five patients with osteoarthritis due to DDH who underwent primary THA were included in this study. The mean final follow-up period was 12.7 ± 1.2 years (range 10-15 years). All cases were evaluated both clinically and radiographically, and Kaplan-Meier survivorship was determined as stem revision for any reason as the end point. RESULTS: Modified Harris hip score averaged 89.0 ± 1.1 (range 60-98) at the final follow-up. The survivorship was 99.0% (95% confidence interval 93.4-99.9%) at 15.0 years, and only one hip with a well-fixed stem required stem revision due to recurrent dislocations. Cortical hypertrophy (CH) was observed in 40 of 105 hips (38.1%), and stress shielding (SS) progressed to grade 3 or 4 in six hips (6 of 105 hips: 5.7%) during the study period. Among the six hips with progressed SS, Dorr type C proximal femoral geometry was seen in five hips. CONCLUSION: This study of 105 THAs using the Bicontact D stem that focused on DDH patients with a minimum 10 year follow-up period achieved satisfactory clinical and radiological outcomes. Dorr type C proximal femoral geometry could be considered a risk factor for progressed SS.

Achievement of optimal implant alignment using taper wedge stems with cup-first THA through the MIS antero-lateral approach.

PURPOSE: Combined anteversion (CA) technique (stem-first procedure) has become generally accepted as an ideal means to achieve optimal CA value in THA. However, we hypothesized that CA technique for patients with various native femoral anteversions could pose a risk of anterior or posterior cup protrusion. In the present study, we examined whether it is possible to use the taper wedge stem to change the stem version to achieve optimal CA while avoiding cup protrusions with the cup-first procedure through minimally invasive (MIS) antero-lateral approach. METHODS: Eighty-one patients underwent cup-first THA with a taper wedge stem. The acetabular cup was placed following the preoperative planning of the cup alignment to avoid anterior cup protrusions using CT-based navigation. Following the CA theory, anteversion of the taper wedge stem was changed to the target anteversion from the patient's native femoral anteversion. The native femoral anteversion, the change in version angle of the stem, postoperative CA and the length of anterior cup protrusions were evaluated in postoperative CT measurements. RESULTS: The native femoral anteversion averaged 25.7° ± 8.9° (range 8°-45°). Cases with increased and decreased stem anteversion were observed in 42 hips (51.8%) and 33 hips (40.7%), respectively. The amount of increased and decreased version angles averaged 7.7° ± 4.8° (range 2°-21°) and 7.8° ± 5.1° (range 2°-20°), respectively. Postoperative CA values averaged 36.7° ± 3.4° (range 29.4°-44.2°) and anterior cup protrusion length averaged 2.0 mm ± 2.6 mm (0 ~ 8.8 mm) in axial view and 0.4 mm ± 1.0 mm (0 ~ 3.6 mm) in sagittal view. Anterior cup protrusion of more than 10 mm was not observed in any hips. CONCLUSION: This procedure can be considered as an option to achieve optimal CA anteversion while avoiding anterior cup protrusion in THA.

New combined anteversion technique in hybrid THA: cup-first procedure with CT-based navigation.

PURPOSE: Combined anteversion (CA) technique (stem-first procedure) is generally accepted as the optimal technique to attain an appropriate CA value in total hip arthroplasty (THA). However, cup anteversion is strongly influenced by the native femoral anteversion. Accordingly, anterior protrusion of the cup in the acetabulum might occur. The purpose of the present study is to investigate the achievement of the optimal CA while avoiding anterior cup protrusion and examine the significance of our new CA technique with cup-first procedure in hybrid THA. METHODS: Seventy-nine hybrid THAs with the cup-first procedure used a CT-based navigation system for cup positioning. In the preoperative planning, cup anteversion was aimed at approximately 20°. However, in actuality, sufficient cup coverage in the original acetabulum based on individual anatomy is given priority over cup placement based on CT-based planning to ensure adequate cup coverage. The target stem anteversion was determined following Widmer's mathematical formula (37.3 = femoral stem anteversion × 0.7 + cup anteversion). Cemented stem was inserted according to the target stem anteversion angle. RESULTS: Regarding the assessment of overall alignment, the calculated Widmer's CA values during surgery and postoperative CT evaluation were 34.1° ± 6.0° (range 20.7°-51.2°) and 35.1° ± 6.7° (range 21.6°-50.7°). There were 72 hips (91.1%) within 25°-50° of CA. Cup protrusion length averaged 2.0 mm ± 2.6 mm (0-8.8 mm) in the axial view and 0.4 mm ± 1.0 mm (0-3.6 mm) in the sagittal view. Cup protrusion length of more than 5 mm was indicated in 10 hips, and no hips observed more than 10 mm. CONCLUSION: Our new CA technique (cup-first procedure) with hybrid THA was able to achieve optimal CA value while avoiding anterior cup protrusion.

Evaluating the Effect of Intravenous Acetaminophen in Multimodal Analgesia After Total Hip Arthroplasty: A Randomized Controlled Trial.

BACKGROUND: Postoperative pain is a significant concern of patients before surgery. Multimodal pain management is an effective method of pain control after major orthopedic surgery. Acetaminophen is the most commonly used analgesic for the management of pain. It was hypothesized that 1000 mg of intravenous acetaminophen (IA) dosed every 6 hours would significantly reduce the postoperative pain score at rest and the opioid consumption volume in patients who would undergo total hip arthroplasty (THA) when compared to a control group. METHODS: A single-center, prospective, open-label randomized control study was conducted. A total of 97 patients undergoing unilateral primary THA were divided into 2 groups: the study group (IA) (n = 45) and the control group (n = 52). The study group received administered IA after surgery, while the control group received only a standard pain control. Both groups received a preoperative femoral nerve block and postoperative intravenous fentanyl citrate. The primary outcome was the evaluation of the pain score at rest 24 hours after surgery. The pain score was measured using the Numerical Rating Scale. The primary outcome of this study was analyzed using generalized estimating equation. RESULTS: The IA group had a significant improvement in Numerical Rating Scale score at rest 24 hours after THA compared to the control group (-0.91, 95% confidence interval -1.56 to -0.26, P = .006), suggesting a positive effect of IA usage for pain relief. The total fentanyl citrate consumption after surgery for 24 hours was significantly lower in the IA group than those of the control group (52.07 ± 7.64 vs 57.83 ± 12.44 mg, P < .001). CONCLUSION: Postoperative administration of IA significantly reduced the postoperative pain score and opioid consumption volume after primary THA. IA was useful as one role of multimodal pain management after THA. LEVEL OF EVIDENCE: Level 2.

Intraoperative kinematic analysis of posterior stabilized total knee arthroplasty with asymmetric helical post-cam design.

PURPOSE: To investigate intraoperative kinematics during passive flexion using a surgical navigation system for knees undergoing posterior stabilized (PS) total knee arthroplasty (TKA) with an asymmetric helical post-cam design using navigation system. METHODS: In total, 45 knees with both pre- and postoperative kinematic data available were included in the study. Intraoperative kinematic measurements were performed during the course of surgery using the software incorporated in the navigation system. Measurements were performed at the following two time points: (1) before TKA procedure and (2) after TKA implantation. Among the kinematic parameters studied, anterior/posterior translation and axial rotation during flexion were subjected to the analysis. RESULTS: Before surgery, physiologic anterior/posterior translational pattern of the tibia during flexion (rollback of the femur) was found in only 15.6% of the knees. After TKA implantation, postoperative kinematic measurement showed no significant change in the tibial translational during knee flexion. Similarly, with regard to rotation, non-physiologic external tibial rotation in early flexion was observed in the majority of the knees before surgery, and this abnormal kinematic pattern remained after the TKA procedure. CONCLUSIONS: The intraoperative three-dimensional motion analysis using a navigation system showed that the physiologic kinematic pattern (anterior translation and internal rotation of the tibia during flexion) of the knee was distorted in osteoarthritic knees undergoing TKA. The abnormal kinematic pattern before surgery was not fully corrected even after implantation of the PS TKA designed to induce natural knee motion; however, no clear relationship between the intraoperative kinematic pattern and knee flexion angle at one year was demonstrated, and the effect of knee kinematics on postoperative knee function and patient's satisfaction is still unclear.

Total hip arthroplasty using stem-first technique with navigation: the potential of achievement of the optimal combined anteversion being a risk factor for anterior cup protrusion.

PURPOSE: In the combined anteversion (CA) technique for total hip arthroplasty (THA) with a cementless stem, cup anteversion is strongly influenced by the native femoral anteversion. It is hypothesized that in cases with large native femoral anteversion, cup anteversion can be decreased, and anterior cup protrusion from the anterior edge of the acetabulum could occur due to the achievement of optimal CA. In this study, the accuracy of CA in THA with the CA technique using imageless navigation and the relationship between the protrusion of the anterior edge of cup and optimum CA was retrospectively evaluated. METHODS: Ninety-seven patients (104 hips) who underwent primary THA by the CA technique using image-free navigation were enrolled in the study. The femoral stem was placed following the individual femoral anteversion so that the target cup anteversion could be determined following a mathematical formula (37 = femoral stem anteversion × 0.7 + cup anteversion). Results The resulting CA values effectively achieved accurate CA with 39.49 ± 5.03° postoperatively. On the other hand, anterior cup protrusion was measured by computed tomography image. A cup protrusion length of more than 3 mm was indicated for 60 cases (57.7%). All included patients were divided into two groups: Group 1 as protrusion positive and Group 2 as protrusion negative. In Group 1, preoperative femoral anteversion and postoperative stem anteversion were significantly higher, while postoperative cup anteversion was significantly lower. However, the postoperative CA value indicated no significant difference between the groups. CONCLUSIONS: The CA (stem-first) technique with image-free navigated THA could effectively achieve accurate CA. On the other hand, a large number of cases revealed anterior cup protrusion due to the low cup anteversion.

Treatment strategy for amyloid hip arthropathy in long-term hemodialysis patients.

BACKGROUND: The number of hemodialysis patients has been progressively increasing in our country. On the other hand, chronic hip arthropathy associated with long-term hemodialysis is a devastating problems affecting patients' quality of life. In our previous study, we proposed a classification system for radiological abnormalities seen in hemodialysis-related hip lesions. The purpose of the study was to propose the surgical strategy for hip disorders caused by long-term hemodialysis. METHODS: Patients with a history of hemodialysis for more than 10 years, 191 hip lesions in 165 consecutive patients who visited our institute due to hip symptoms. Various abnormalities were identified in 116 out of 191 hips. A retrospective assessment of the patient record and radiographs was performed for the included subjects examining the natural course of the disease process as well as the results of surgical treatment. RESULTS: Seventy-six hip lesions (69.0%) were conservatively managed at the time of the initial visit. Surgeries were performed for 75 hips (64.7%) during the study period. Among those, surgical treatment was indicated for 40 hips at the time of the initial visit. On the other hand, surgeries were performed for 35 hips during the subsequent follow-up period due to progression of the disease process. CONCLUSIONS: Based on the analysis of our surgical experiences by the retrospective chart review, we have established a flowchart of the treatment strategy for chronic hip arthropathy in long-term hemodialysis patients. STUDY DESIGN: This study is retrospective clinical study.

Accuracy of combined anteversion in image-free navigated total hip arthroplasty: stem-first or cup-first technique?

PURPOSE: In total hip arthroplasty (THA), combined anteversion (CA) is used as a parameter for assessment of overall prosthetic alignment. The purpose of this study was to comparatively examine the CA value in patients who underwent primary THA using the image-free navigation system either with a cup-first or stem-first technique. METHODS: Eighty-three hips undergoing primary THA using the OrthoPilot® image-free navigation system (B. Braun-Aesculap, Tuttlingen, Germany) were included in this study. The patient population was divided into two groups depending on the procedure used: cup-first technique and stem-first technique. In the cup-first group, inclination and anteversion (AV) angles were targeted at 35-45° and 15-25°, respectively, while stem antetorsion (AT) was determined for each patient based on the amount of individual native femoral AT angle. In the stem-first group, the femur was prepared first with the target angle corresponding to the native femoral AT and the cup AV was decided considering the CA calculated with Widmer's formula (aiming at the optimal Widmer's CA of 37.3°). RESULTS: Better consistency in Widmer's CA values was attained in the stem-first group as indicated by the smaller SD values. In the assessment of overall alignment, Widmer's CA values were within the satisfactory range (37 ± 5°) in 41.9 and 92.3 % of the subjects in the cup-first group and the stem-first group, respectively. CONCLUSIONS: The stem-first technique with image-free navigated THA could effectively achieve accurate and consistent control of the CA value and thus is expected to improve the surgical outcome.

Arthroscopic labral repair concomitantly performed with curved periacetabular osteotomy.

A 23-year-old female presented with pain in the left hip. Radiological examination showed developmental dysplasia of the hip (DDH) combined with acetabular retroversion and posterior wall deficiency. Findings in the physical examination were coincident with femoroacetabular impingement. At surgery, we performed curved periacetabular osteotomy concomitant with arthroscopic labral repair and osteochondroplasty, simultaneously addressing dysplastic acetabulum and femoroacetabular impingement. The final follow-up examination at 18 months showed satisfactory outcome with the D'Aubigne and Postel hip score of 17/18. In addition to accurate diagnosis, the arthroscopic procedure for associated intra- and peri-articular problems seems to help improve the surgical outcome of periacetabular osteotomy performed for patients with DDH.

Significance of preoperative 3D-CT angiography for localization of the femoral artery in complicated THA.

BACKGROUND: Major vascular injury is one of the most devastating complications in total hip arthroplasty (THA). Risk for intraoperative vascular injury is increased when the normal vascular anatomy is distorted by previous surgery or dislocation with displacement. Therefore, an appreciation of the vascular anatomy in relation to the anticipated surgical field is critical to avoid this complication during preoperative assessment for a complicated THA. METHODS: Preoperative three-dimensional (3D) CT angiography was performed for 24 complicated THAs when altered vascular anatomy around the acetabulum was suspected. When assessing the CT images, the presence of apparent proliferation of vessels close to the original acetabulum as well as a distance of <10 mm from the artery to the acetabulum was deemed a potential risk factor for intraoperative vascular injury. Additionally, the relationships of clinical characteristics and the presence of these risk factors were analyzed to identify the patient population at risk. RESULTS: The incidence of proliferation of collateral vessels was higher in patient groups with proximal femoral migration of 5 cm or more and multiple previous surgeries prior to the index THA. Moreover, in three ankylosed hips, lateral deviation of the main vascular trunk with an artery-acetabulum distance of <10 mm was identified in all cases. CONCLUSION: Preoperative 3D-CT angiography in cases of complicated THA revealed altered vascular anatomy which may increase the risk for intraoperative vascular injuries. Patient characteristics related to the risk for this complication were marked proximal femoral migration, multiple previous surgeries, and hip ankylosis. Preoperative image examination of the vascular anatomy is thought to help reduce the risk of inadvertent vascular injury in these complicated THA cases.

Comparative Study for Postoperative Initial Fixation Patterns of Two Different Types of Cementless Short Stem Using Three-Dimensional Templating Software.

Background: While cementless short stems have become popular in total hip arthroplasty (THA), Metha is a relatively recent development that differs from other short stems in its initial fixation concept of partial collum-sparing metaphyseal anchorage. The purpose of this study was to quantify the contact state between Metha and the femur. Additionally, we investigated the difference in contact points between Meta and Fitmore, which is one of the more popular curved short stems. Methods: We conducted a retrospective review of 42 hips that underwent THA using Metha and 41 hips using Fitmore. Stem-to-femur contact was evaluated by density mapping using a three-dimensional digital template system to quantify the contact condition according to the modified Gruen zone. The criterion for the stem-to-bone contact boundary was defined as a computed tomography value of 543 Hounsfield. Results: Quantitative evaluation of Metha according to the modified Gruen zones showed the ratio of surface area with high cortical contact in each zone. The results were 4.6% ± 5.7% in zone 1, 0.9% ± 2.3% in zone 2, 19.1% ± 12.9% in zone 3, 1.4% ± 3.2% in zone 5, 29.6% ± 16.4% in zone 6, and 25.1% ± 17.7% in zones 7. Evaluation of Fitmore for the same zones was as follows: 1.6% ± 2.4%, 18.5% ± 16.9%, 20.8% ± 17.4%, 12.7% ± 12.8%, 3.7% ± 5.8%, and 13.3% ± 10.3%. Comparing the two groups, the contact area was significantly greater for Metha in zones 1, 6 and 7 and Fitmore in zones 2 and 5 (p < 0.05). Conclusions: It is possible for Metha to achieve metaphyseal anchoring by contacting the cortical bone at the proximal femur, thus avoiding proximal offloading. To the best of our knowledge, no previous studies have quantitatively reported stem-to-cortical bone contact conditions in curved short stems.

Fascia iliaca compartment block: its efficacy in pain control for patients with proximal femoral fracture.

BACKGROUND: Proximal femoral fractures are common in elderly patients. Recently, use of regional blockade has gained popularity as a means of relieving pain among this patient population. Among the procedures, fascia iliaca compartment block (FICB) is believed to be advantageous because of its safety and efficacy. METHODS: In this study fifty-six consecutive patients who sustained a proximal femoral fracture were assigned to two groups. For 31 patients in group 1, FICB was used to control pre and postoperative pain. FICB was performed by an orthopaedic resident on arrival of the patient at the hospital and in the immediate postoperative period. Systemic administration of non-steroidal anti-inflammatory drugs (NSAIDs) alone was adopted for pain control for 25 patients in group 2. The severity of pain was assessed by use of a visual analog scale (VAS). RESULTS: Neither blockade-associated complications nor analgesic failure were encountered among patients who underwent FICB (group 1). In this group of patients, the mean preoperative VAS scores before FICB and at 10 min and 12 h after the blockade were 91, 31, and 36 respectively, indicating significant pain reduction. The corresponding values for group 2 patients were 92, 92, and 81. In addition, postoperative pain was also successfully managed by FICB with mean VAS scores at immediate, 6-h and 12-h time points of 15, 22, and 31 respectively, whereas the corresponding values for the group 2 patients were 62, 49, and 59. Consequently, significant differences in VAS scores were demonstrated between the groups in both the pre and postoperative periods. CONCLUSION: FICB is clinically safe and efficient, providing consistent analgesic effects irrespective of the performing doctor's experience of elderly patients with proximal femoral fracture.

Difficult Preoperative Diagnosis of Suspected Metal Hypersensitivity in a Case with Early Failure of Bipolar Hemiarthroplasty.

Background: Metal hypersensitivity is a rare complication after total hip arthroplasty (THA), and no reliable diagnostic method for metal hypersensitivity to orthopedic metal implants has yet been established. Case report. A 57-year-old woman underwent hemiarthroplasty using a metal implant despite a skin allergy to metal jewelry. Two years after surgery, the patient developed early hemiarthroplasty failure and refractory erythema. Although the patient was clinically suspected to have a hypersensitivity to metal, the preoperative screening test was negative, and patient underwent revision surgery with cemented THA. Postoperatively, the erythema as well as her hip pain disappeared completely. Conclusion: Patients with clinically suspected metal hypersensitivity should undergo primary and revision total hip arthroplasty using hypoallergenic implants regardless of preoperative screening results.

Abrogation of Treg function deteriorates rheumatoid arthritis.

An early prognostic indicator which warns of progressive joint destruction of rheumatoid arthritis (RA) was explored using a novel suspension-array technique in moderate (Steinbrocker stage I and II) and severe (Steinbrocker stage IV) RA patients. DNA microarray analysis of peripheral blood lymphocytes showed significant increase of interleukin (IL)-2 receptor α-chain (CD25) gene expression, a regulatory T cell (Treg) surface marker in severe RA patients. In contrast, suspension array, a comprehensive bead-based enzyme-linked immunosorbent assay (ELISA), revealed decreased production of IL-10 and increased production of interferon (IFN)-γ in sera in the incipient stage of the aggressive disease process. Both in moderate and in severe RA patients, the IFN-γ/IL-10 ratio indicated deterioration of the disease with universal validity. Fluorescence-activated cell sorting (FACS) and reverse-transcription polymerase chain reaction (RT-PCR) analysis showed extant CD4+CD25+ regulatory T cells in severe RA patients, however Foxp3, a regulatory T cell-specific transcription factor, gene expression was absent, while glucocorticoid-induced tumor necrosis factor (TNF) receptor family-related protein (GITR), which transmits a signal that abrogates regulatory T cell functions, was elevated. In the current study, we showed the validity of suspension-array analysis for enabling more complete understanding of RA, and showed that IFN-γ/IL-10 ratio can be a prognostic tool for early lesion and more aggressive RA.

Treatment of Severe Hip Dysplasia with Leg Length Discrepancy Using Spherical Periacetabular Osteotomy.

Case. A 20-year-old woman with severe subluxation of the hip displayed a leg length discrepancy of approximately 20 mm. The proposed treatment was a spherical periacetabular osteotomy (SPO) for joint preservation and postoperative leg length maintenance. SPO is a novel periacetabular osteotomy procedure. At her 3-year follow-up, the patient had functional, pain-free motion and high satisfaction. In this case, the SPO technique was able to achieve satisfactory clinical results without further exacerbating the leg length discrepancy after surgery.

Adjustment of leg length using imageless navigation THA software without a femoral tracker.

BACKGROUND: Adjustment of leg length discrepancy is an important factor influencing the outcome of total hip arthroplasty (THA). However, leg length discrepancy after THA has been reported to be associated with inferior clinical outcome in previous studies. A new version of the imageless navigation software "OrthoPilot THAplus" has been developed to assess the leg length adjustment and offset value. The clear advantage of this system is the elimination of the need for femoral pin insertion, which is associated with potential complications and additional surgical invasion. METHODS: In this study, the accuracy of this newly developed system was evaluated in 50 consecutive hips implanted with primary THA. The operative results of these 50 patients were compared with those of another 50 consecutive primary THA patients operated on with the previous navigation system that was not equipped with the leg length adjustment system. RESULTS: After surgery, the average leg length discrepancy in the THA plus group was 0.9 mm (range -5 to 5 mm), while the corresponding value in the other group with the older software was 2.9 mm (range -13 to 20 mm), showing a significant difference. CONCLUSION: The accuracy and reproducibility of new software added to the imageless THA navigation system in achieving equalization of leg length were assessed. Comparison of the surgical results as compared with the control group performed with the conventional navigation system showed the advantage of this system over the previous system.

Revision Total Hip Arthroplasty due to Catastrophic Osteolysis Caused by Massive Chronic Expanding Hematoma.

An 84-year-old woman who underwent bilateral cementless total hip arthroplasty (THA) for dysplastic osteoarthritis 22 years ago was subjected to analysis. A huge soft-tissue mass was revealed in her left medial thigh. Plain radiographs of the left hip joint revealed severe osteolysis around the stem, cup, and ischium. Magnetic resonance imaging showed a 25 × 14-cm multilobulated mass with a thick-walled pseudocapsule. Two-stage surgery was performed with resection of the mass followed by a subsequent revision THA. The mass was diagnosed as a chronic expanding hematoma through gross and histologic findings. Two years after the revision THA, there was no recurrence of a hematoma. Two-stage revision THA was useful for definitive diagnosis, and good functional recovery was obtained after surgery.

Total Hip Arthroplasty Concomitant with Patellofemoral Arthroplasty and Medial Patellofemoral Ligament Reconstruction for a Patient with Patellar Dislocation Combined with Hip Dysplasia: A Case Report of a Successful Outcome at 5-Year Follow-Up.

BACKGROUND: Posttraumatic patellar dislocation is rare, and consistent surgical strategy therefore has not been defined due to multifactorial factor. In this case study, we treated a case of a patellar dislocation with hip osteoarthritis and increased femoral anteversion by performing a two-staged surgery. In the first stage, total hip arthroplasty was performed, and in the second stage, simultaneous patellofemoral arthroplasty and medial patellofemoral ligament reconstruction using semitendinosus tendon autograft were performed. Case Report. A 56-year-old female patient who previously had right hip osteoarthritis complained of right knee pain after a fall. Radiographic examination showed lateral dislocation of the patella with osteoarthritic (OA) change in the patellofemoral joint and an excessive femoral anteversion with OA change on the right hip joint. Total hip arthroplasty was performed firstly to decrease femoral anteversion. Then, simultaneous patellofemoral arthroplasty and medial patellofemoral ligament reconstruction was performed for residual patellar dislocation and patellofemoral OA without tibiofemoral joint OA. At the time of the 5-year follow-up after surgery, the patient was able to walk with a wheelbarrow without any complications. CONCLUSION: To the best of our knowledge, this is the first case of a patellar dislocation with an increased femoral anteversion and patellofemoral OA treated by a combination of total hip arthroplasty, patellofemoral arthroplasty, and medial patellofemoral ligament reconstruction. The clinical outcome improved at 5 years after these surgeries. Therefore, these surgical options can be considered to be useful.