BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation,Girdlestone resection arthroplasty(GRA)is a viable treatment option.We report on a patient who was treated with a GRA due to a ...BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation,Girdlestone resection arthroplasty(GRA)is a viable treatment option.We report on a patient who was treated with a GRA due to a periprosthetic infection.We discovered partial paralysis of the quadriceps muscle in this patient.We investigated the femoral nerve anatomy,particularly the nerve entry points,to better understand this phenomenon.AIM To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.METHODS Eight cadaveric hemipelves were investigated.The branches of the femoral nerve were dissected and traced distally.The GRA was performed by the direct anterior approach.Axial stress to the lower extremity was applied,and the relative movement of the femur was recorded.The femoral nerve and its entry points were assessed.RESULTS GRA led to a 3.8 cm shift of the femur in vertical direction,a 1.8 cm shift in the dorsal direction,and a 2.3 cm shift in the lateral direction.A 36.5°external shift was observed.This caused stress to the lateral division of the femoral nerve.We observed migration of the femoral nerve entry point at the following locations:(1)Vastus medialis(5.3 mm);(2)The medial part of the vastus intermedius(5.4 mm);(3)The lateral part of the vastus intermedius(16.3 mm);(4)Rectus femoris(23.1 mm);(5)Tensor vastus intermedius(30.8 mm);and(6)Vastus lateralis(28.8 mm).CONCLUSION Migration of the femur after GRA altered the anatomy of the femoral nerve.Stress occurred at the lateral nerve division leading to poor functional results.展开更多
BACKGROUND Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip,involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer,followed by ...BACKGROUND Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip,involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer,followed by antibiotic therapy before reimplantation.AIM To compare the outcomes and complications of two consecutive treatment protocols for two-stage revision arthroplasty of the infected hip:One using Girdlestone with an antibiotic holiday,the other using custom-made articulating spacers(CUMARS)without an antibiotic holiday.METHODS In this retrospective study,two consecutive cohorts were compared.Group A(2017-2020)underwent two-stage revision with a Girdlestone and an antibiotic holiday before reimplantation,while Group B(2020-2023)received CUMARS whenever possible,and no antibiotic holiday,or a Girdlestone if indicated.The primary outcome was successful infection eradication after one year.Secondary outcomes included surgical duration,length of hospital stay,weight-bearing allowance,discharge destination,and complications.RESULTS A total of 98 patients were included:39 patients in Group A and 59 patients in Group B.Successful infection eradication after one year was achieved in 69%of Group A and 83%of Group B(P=0.164).Patients in Group B were more frequently allowed to bear weight(64%vs 18%,P<0.001),had a shorter in-hospital stay(9 vs 16 days,P<0.001),and were more often discharged home after the first surgery(48%vs 24%,P=0.048).No significant differences were found in(mechanical)complications.CONCLUSION A protocol including CUMARS is a safe and effective treatment,offering faster recovery,shorter length of hospital stay,and enabling more patients to return home during the interval.This reduces strain on patients and the healthcare system,potentially saving costs,without compromising infection control or increasing(mechanical)complications.展开更多
文摘BACKGROUND When patients with a failed hip arthroplasty are unsuitable for reimplantation,Girdlestone resection arthroplasty(GRA)is a viable treatment option.We report on a patient who was treated with a GRA due to a periprosthetic infection.We discovered partial paralysis of the quadriceps muscle in this patient.We investigated the femoral nerve anatomy,particularly the nerve entry points,to better understand this phenomenon.AIM To reveal the femoral nerve anatomy with respect to severe proximal migration after GRA.METHODS Eight cadaveric hemipelves were investigated.The branches of the femoral nerve were dissected and traced distally.The GRA was performed by the direct anterior approach.Axial stress to the lower extremity was applied,and the relative movement of the femur was recorded.The femoral nerve and its entry points were assessed.RESULTS GRA led to a 3.8 cm shift of the femur in vertical direction,a 1.8 cm shift in the dorsal direction,and a 2.3 cm shift in the lateral direction.A 36.5°external shift was observed.This caused stress to the lateral division of the femoral nerve.We observed migration of the femoral nerve entry point at the following locations:(1)Vastus medialis(5.3 mm);(2)The medial part of the vastus intermedius(5.4 mm);(3)The lateral part of the vastus intermedius(16.3 mm);(4)Rectus femoris(23.1 mm);(5)Tensor vastus intermedius(30.8 mm);and(6)Vastus lateralis(28.8 mm).CONCLUSION Migration of the femur after GRA altered the anatomy of the femoral nerve.Stress occurred at the lateral nerve division leading to poor functional results.
文摘BACKGROUND Two-stage revision is the most common treatment for chronic periprosthetic joint infection of the hip,involving a resection arthroplasty with or without placement of an antibiotic-loaded spacer,followed by antibiotic therapy before reimplantation.AIM To compare the outcomes and complications of two consecutive treatment protocols for two-stage revision arthroplasty of the infected hip:One using Girdlestone with an antibiotic holiday,the other using custom-made articulating spacers(CUMARS)without an antibiotic holiday.METHODS In this retrospective study,two consecutive cohorts were compared.Group A(2017-2020)underwent two-stage revision with a Girdlestone and an antibiotic holiday before reimplantation,while Group B(2020-2023)received CUMARS whenever possible,and no antibiotic holiday,or a Girdlestone if indicated.The primary outcome was successful infection eradication after one year.Secondary outcomes included surgical duration,length of hospital stay,weight-bearing allowance,discharge destination,and complications.RESULTS A total of 98 patients were included:39 patients in Group A and 59 patients in Group B.Successful infection eradication after one year was achieved in 69%of Group A and 83%of Group B(P=0.164).Patients in Group B were more frequently allowed to bear weight(64%vs 18%,P<0.001),had a shorter in-hospital stay(9 vs 16 days,P<0.001),and were more often discharged home after the first surgery(48%vs 24%,P=0.048).No significant differences were found in(mechanical)complications.CONCLUSION A protocol including CUMARS is a safe and effective treatment,offering faster recovery,shorter length of hospital stay,and enabling more patients to return home during the interval.This reduces strain on patients and the healthcare system,potentially saving costs,without compromising infection control or increasing(mechanical)complications.
