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Novel surgery could help avoid total hip replacement | Young patients with a specific traumatic injury to the hip joint can now avoid a hip replacement by going for surgery using transplanted bone and cartilage, according to a case study by orthopaedic trauma specialists at Hospital for Special Surgery in New York. Hip replacements typically last 20 to 25 years, so a younger
person who undergoes a hip replacement is likely to need multiple hip replacement
surgeries/revisions in the span of his or her lifetime. "This novel technique
can help young patients to delay, or even possibly avoid altogether, the need
for a total hip replacement," said Dr. David L. Helfet, director of the Orthopaedic
Trauma Service at Hospital for Special Surgery. In certain high-energy accidents
such as motor vehicle accidents or when a person falls off a ladder, fractures
of the so-called femoral head can occur. The hip consists of a ball and socket
joint and a femoral head fracture is an injury to the ball portion of the joint.
In high-energy accidents, the femur can be forced to dislocate beyond the socket
often causing a femoral head fracture, sometimes with an associated fracture to
the hip socket. Researchers at Hospital for Special Surgery reported a case, which
involved an injury to an 18-year-old man who was a belted driver involved in a
motor vehicle collision, striking a pole. After being admitted and observed at
the initial hospital, he was assessed as having a small fracture of the femoral
head and was released on crutches. Twenty days following the injury, he presented
at Hospital for Special Surgery. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations were performed, which further delineated the large
displaced section of the femoral head and a small associated fracture to the periphery
of the hip socket (acetabulum). The surgeons performed the surgery using a new
technique that involves surgical dislocation of the femur in order to access and
repair the fracture. Because one-third of the femoral head was missing due to
the severe damage associated with the injury, doctors chose to transplant a special
piece of frozen bone/cartilage. Hospitals, especially those with larger orthopedic
surgery departments, have bone bank facilities that store bone and cartilage tissue
based on surgical indications. Once thawed, the cartilage and bone were shaped
to fit into the defect. The transplant was then anchored into place with two small
headless screws. "This is one of the first such case reports describing this procedure
in the orthopaedic literature. The patient has had an early good functional recovery
following such a severe injury to his hip joint," said Helfet. Post-operatively,
the patient was on crutches, only 20 lbs weight bearing for two months, but he
was told to avoid rigorous activities requiring further exertion. Subsequently,
the patient was allowed to slowly progress to weight bearing as tolerated and
work on obtaining full range of motion and strength of the hip. At 46 months following
surgery, the patient is fully rehabilitated, was able to successfully complete
his education, and has been able to return to the active life he enjoyed before
the injury. Helfet said: "The advantage of this surgery is the ability to delay
or even avoid altogether a total hip replacement. Even more importantly, the longer
a hip replacement can be delayed in a younger patient, the better, because there
is less chance of one or multiple subsequent revision surgeries." The study appears
in the February issue of the Journal of Orthopaedic Trauma. |
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