Background: Hip osteoarthritis is a condition that leads to significant morbidity and decreases the quality of patient’s life. Total Hip Arthroplasty (THA) is preferred by most of orthopaedic surgeons to relieve pain, provide motion while maintaining stability. In this study we aim to discuss the difficulties encountered in reference to patho-anatomy during THA in various conditions along with their solutions.
Materials and Methods: In our study, we had observed 100 hip
joints of secondary osteoarthritis in 67 patients of with different type of
underlying pathology like avascular necrosis, sickle cell disease, rheumatoid
arthritis, ankylosing spondylitis. All the patients were evaluated using
modified harris hip score. The findings were evaluated using SPSS software
(Ilionois, Chicago) with p value less than 0.05 considered as significant.
Observation and Results: We had operated 100 hip joints
(n=100) having arthritic changes among 67 patients (33 patients with bilateral
hip affection, 34 patients with unilateral hip affection) at our tertiary care
hospital from June 2015 till December 2019. The mean Harris Hip Score at the
final follow up was 88 among them 98 hip joints had excellent and 2 hip joints
had good to fair results. During our study we majorly encountered three types
of collapse – Anterosuperior collapse (56%), Concentric collapse (25%) and hip
arthritis due to inflammatory conditions (19%). We had found that according to
duration and types of collapse different soft tissues were contracted and a
step-wise release of those structures is necessary for proper intra-operation
reduction and post-operative better range of motion. The steps for global
release as and when required in different patients include adductor tenotomy,
release of external rotator muscles, release of anterior fibers of gluteus medius, release of tensor fascia lata
and tendinous insertion of gluteus maximus along with release of posterior
capsule, release of anterior capsule followed by release of iliopsoas tendinous
insertion on lesser trochanter.
Conclusion: The chronicity of the disease will lead to
anatomical changes of the surrounding soft tissue and that will affect the
surgical dissection. We had described surgical problems encountered during the
operation and their solutions for each type of pathoanatomy. This will help
orthopedic surgeons to anticipate and prepare well in advance while performing
total hip arthroplasty.
Author(s) Details:
Paresh Golwala,
SBKS& MIRC, Sumandeep Vidyapeeth (Deemed to be University), India.
Parth N. Rathi,
MM Hospital & Hariom Trust, Adipur, Bhuj Kutch 370205, Gujarat, India.
Prassana Shah,
Department of Orthopedics, Dhiraj Hospital, Smt. BK Shah Medical Institute & Research Centre, Sumandeep Vidyapeeth (Deemed to be University), Waghodia, Vadodara 391760, Gujarat, India.
Please see the link here: https://stm.bookpi.org/ANUMS-V10/article/view/13927
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