Subtrochanteric femoral shortening for hip centre restoration in complex total hip arthroplasty with functional outcome.

AIMS: Complex total hip arthroplasty (THA) with subtrochanteric shortening osteotomy is necessary in conditions other than developmental dysplasia of the hip (DDH) and septic arthritis sequelae with significant proximal femur migration. Our aim was to evaluate the hip centre restoration with THAs in these hips. METHODS: In all, 27 THAs in 25 patients requiring THA with femoral shortening between 2012 and 2019 were assessed. Bilateral shortening was required in two patients. Subtrochanteric shortening was required in 14 out of 27 hips (51.9%) with aetiology other than DDH or septic arthritis. Vertical centre of rotation (VCOR), horizontal centre of rotation, offset, and functional outcome was calculated. The mean followup was 24.4 months (5 to 92 months). RESULTS: The mean VCOR was 17.43 mm (9.5 to 27 mm) and horizontal centre of rotation (HCOR) was 24.79 mm (17.2 to 37.6 mm). Dislocation at three months following acetabulum reconstruction required femoral shortening for offset correction and hip centre restoration in one hip. Mean horizontal offset was 39.72 (32.7 to 48.2 mm) compared to 42.89 (26.7 to 50.6 mm) on the normal side. Mean Harris Hip Score (HHS) of 22.64 (14 to 35) improved to 79.43 (68 to 92). Mean pre-operative shortening was 3.95 cm (2 to 8 cm). Residual limb length discrepancy was 1.5 cm (0 to 2 cm). Sciatic neuropraxia in two patients recovered by six months, and femoral neuropraxia in one hip recovered by 12 months. Mean Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was 13.92 (9 to 19). Mean 12-item short form survey (SF-12) physical scores of 50.6 and mental of 60.12 were obtained. CONCLUSION: THA with subtrochanteric shortening is valuable in complex hips with high dislocation. The restoration of the hip centre of rotation and offset is important in these hips. LEVEL OF EVIDENCE IV: Femoral shortening useful in conditions other than DDH and septic sequelae.Restoration of hip centre combined with offset to be planned and ensured.

Arthroscopic Excision of Juxta-articular Osteoid Osteoma of the Calcaneum.

Osteoid osteoma of the foot is a rare condition particularly of the calcaneum. This condition is difficult to diagnose and is more difficult to treat particularly if it involves deeper part of the joints. We present an arthroscopic technique to deal with a case of juxta-articular osteoid osteoma of the calcaneum using two portals: the anterolateral portal for instrumentation and the anterior anterolateral portal for visualization of the subtalar joint. Because this approach is minimally invasive, it offers early recovery and reduced morbidity compared with the conventional techniques.

Idiopathic chondrolysis of the hip: medium- to long-term results.

BACKGROUND: Chondrolysis of the hip secondary to severe trauma, prolonged immobilization and slipped capital femoral epiphysis have been well documented. There have not been many reports, however, of idiopathic chondrolysis of the hip. We here present our experience with 21 hips with an average follow-up of 23.4 months. METHODS: Twenty patients (21 hips), with gross deformities of the hip who presented with fibrous ankylosis were treated over a 23-year period. Average age at presentation was 13 years. None of the patients responded to a trial of conservative treatment (non-steroidal anti-inflammatory medications, traction and physiotherapy.) RESULTS: Most of the preoperative deformities were corrected following arthrotomy, capsulectomy and skeletal traction. However, return of normal hip motion was not seen in any of the patients. Fibrous ankylosis in a functional position was seen to develop in two patients; one patient underwent hip arthrodesis, while another with bilateral involvement underwent excision arthroplasties. CONCLUSIONS: Circumferential capsulectomy with aggressive mobilization of the hip can correct the deformities associated with this condition, although long-term results are uniformly disappointing with regard to return of hip joint motion in cases of late presentation.

Fate of bone grafting for acetabular defects in total hip replacement.

BACKGROUND: The use of allografts and autografts in the management of acetabular defects have been reported with varying results. Trabecular metal is an expensive option in the management of these defects. This study aims to assess the fate and efficacy of bone grafting for acetabular bone defects in total hip arthroplasty. MATERIALS AND METHODS: A total of 30 hips in 28 patients with acetabular deficiencies were treated with bone grafting and total hip replacement (THR). Seventeen hips had American Academy of Orthopedic Surgeons (AAOS) type 2 (Paprosky type 2c) deficiency and 13 had AAOS type 3 (Paprosky type 3a) defects of the acetabulum. Allografts were used in 15 patients and autografts were used in the remaining 13. Cemented total hip arthroplasty was done in 18 hips and uncemented THR in 12. Seven patients underwent the procedure for, acetabular erosion and symptoms following hemiarthroplasty (4 out of 7), or, acetabular revision for failure (3 out of 7) following total hip arthroplasty. Acetabular deficiencies in other patients were due to posttraumatic causes, advanced primary hip arthritis and second stage treatment of postinfective arthritis. A mesh was used in 6 hips and screws were used in 13 hips for graft fixation. RESULTS: Patients were followed up clinicoradiologically for a period of 10 months to 4 years (mean 23.4 months). One patient required staged revision due to infection. Two patients had early asymptomatic cup migration. One patient had graft lysis and change in cup inclination with persistent pain. He was not keen on further intervention at last followup. Other patients were pain free at the time of followup with radiographs showing maintenance of graft and implant position. CONCLUSION: Bone grafting is a suitable option in the management of acetabular defects in total hip arthroplasty, especially in resource challenged countries.