Publications by authors named "Christophe Pattyn"

25 Publications

  • Page 1 of 1

Fracture risk during extraction of well-fixed extended cementless stems : porous versus hydroxyapatite coated.

Acta Orthop Belg 2021 Mar;87(1):41-45

The concern of extensive fracturing and bone damage during implant removal has been reported for ingrowing stems, in particular in extended porous coated stems, potentially impeding successful re- implantation of a femoral revision implant and consequently debilitating patients for life. The aim of the present study is to describe this particular complication and comparing the occurrence in porous coated and hydroxyapatite (HA) coated femoral implants. 62 consecutive revision hip replacements were per- formed between January 2010 and December 2016 at a single academic institution. Only revisions of a primary total hip replacement were included. All surgeries were performed by the same senior surgeon. Clinical follow-up involved examination with the Harris hip score (HHS) at 2 years post surgical intervention. Fracture occurrence and severity were compared between groups by means of the Vancouver classification for intraoperative fractures. Overall, significant higher rates of fracturing were observed in the porous coated group (81.8%, p<0.05) compared to the HA coated group (43.5%, p<0.05). Of these fractures, the majority (72,7%) were B3 fractures. There was a significant difference between the mean HHS in the porous-coated group versus the group with HA coating (mean Harris Hip Scores of 68,45 vs 86,17, p = .004). Surgeons have to be wary with implanting porous coated stems in primary hip arthroplasty, especially in younger patients who have a high likelihood of future revision surgery, due to the catastrophic peri-operative fractures associated with the removal of these stems.
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March 2021

Personalized hip joint kinetics during deep squatting in young, athletic adults.

Comput Methods Biomech Biomed Engin 2020 Jan 6;23(1):23-32. Epub 2019 Dec 6.

Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium.

The goal of this study was to report deep squat hip kinetics in young, athletic adults using a personalized numerical model solution based on inverse dynamics. Thirty-five healthy subjects underwent deep squat motion capture acquisitions and MRI scans of the lower extremities. Musculoskeletal models were personalized using each subject's lower limb anatomy. The average peak hip joint reaction force was 274 percent bodyweight. Average peak hip and knee flexion angles were 107° and 112° respectively. These new findings show that deep squatting kinetics in the younger population differ substantially from the previously reported in vivo data in older subjects.
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http://dx.doi.org/10.1080/10255842.2019.1699539DOI Listing
January 2020

Conventional versus direct magnetic resonance imaging in detecting labral lesions in femoroacetabular impingment - a retrospective multicenter study.

Acta Orthop Belg 2019 Mar;85(1):100-106

The purpose of this study was to assess the reliability of Direct Magnetic Resonance Arthography (MRA) and Conventional Magnetic Resonance Imaging (MRI) in diagnosing labral lesions in patients with symptoms of femoroacetabular impingement (FAI). Materials and methods: Imaging and surgical data (n=490) were retrospectively collected from 5 high-volume centres providing arthroscopic treatment of FAI patients. Preoperative magnetic resonance imaging findings were compared with the actual surgical findings regarding labral condition in order to assess the effectiveness of MRI and MRA in identifying the presence of labral tears in patients with FAI. The results of this study indicate that MRI and MRA may both be useful for the diagnosis of acetabular labral lesions. The accuracy is slightly higher for MRI (71,4 %) compared to MRA (68,2 %), although MRA has higher sensitivity (74.4%,) as compared to MRI (66,9%). Conclusions: In a clinically suspected labral tear MRA has higher sensitivity than MRI. Further studies on asymptomatic patients may be needed to determine the specificity of different MRI techniques.
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March 2019

Dual-mobility socket in challenging total hip arthroplasty: 2-6 years follow-up.

Acta Orthop Belg 2018 Jun;84(2):149-153

The success of dual-mobility sockets in achieving implant stability in primary hip replacement is already well established. However, stability cannot always be achieved, especially when dealing with more difficult indications. At our department, 104 dual-mobility sockets (92 uncemented and 12 cemented) were implanted for primary total hip arthroplasty in 97 patients between 2009 and 2013. Indications for hip arthroplasty included primary and secondary coxarthrosis, acetabular and subcapital fractures, avascular necrosis, tumor surgery and metastatic fractures. Although no loosenings were observed, 2 dislocations and 1 infection occurred shortly after surgery. In this challenging group of patients no fixation problems or intraprosthetic dislocations have been observed. The design therefore seems to be a valid alternative to constrained implants, especially in high-risk cases, although dislocation cannot be prevented at all times. Although the findings are very promising, long-term survival studies are mandatory to evaluate intraprosthetic stability and fixation longevity of dual-mobility sockets.
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June 2018

The History of Biomechanics in Total Hip Arthroplasty.

Indian J Orthop 2017 Jul-Aug;51(4):359-367

Department of Orthopaedics Surgery and Traumatology, Ghent University Hospital, Ghent 9000, Belgium.

Biomechanics of the hip joint describes how the complex combination of osseous, ligamentous, and muscular structures transfers the weight of the body from the axial skeleton into the appendicular skeleton of the lower limbs. Throughout history, several biomechanical studies based on theoretical mathematics, , as well as models have been successfully performed. The insights gained from these studies have improved our understanding of the development of mechanical hip pathologies such as osteoarthritis, hip fractures, and developmental dysplasia of the hip. The main treatment of end-stage degeneration of the hip is total hip arthroplasty (THA). The increasing number of patients undergoing this surgical procedure, as well as their demand for more than just pain relief and leading an active lifestyle, has challenged surgeons and implant manufacturers to deliver higher function as well as longevity with the prosthesis. The science of biomechanics has played and will continue to play a crucial and integral role in achieving these goals. The aim of this article, therefore, is to present to the readers the key concepts in biomechanics of the hip and their application to THA.
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http://dx.doi.org/10.4103/ortho.IJOrtho_280_17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5525516PMC
August 2017

Contamination risk of synovial biopsy cultures in total hip arthroplasty: a prospective review of 100 cases.

Hip Int 2017 Nov 19;27(6):595-598. Epub 2017 Jul 19.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent - Belgium.

Introduction: Cultures of deep synovial biopsies remain an important tool in diagnosing periprosthetic joint infection, a devastating complication following total hip arthroplasty (THA). Recent reports of unexpected positive intraoperative cultures in aseptic revision arthroplasty, however, challenge the validity and interpretation of these cultures. The aim of this study was to evaluate the contamination risk of synovial biopsy cultures collected intraoperatively during primary THA of healthy subjects.

Methods: Synovial biopsies for culture were collected during primary total hip arthroplasty procedures from 100 consecutive cases. The synovial biopsies were taken within the first 15 minutes after skin incision. Biopsy specimen were cultured on 4 different media for 8 or 15 days. Positive cultures were identified using Maldi-Tof spectrometry.

Results: 16 cultures yielded a bacterium, suggesting a false positive result of 16%. The mean time for the cultures to become positive was 6.29 days (standard deviation [SD] 3.90) with a maximum of 15 days. Proprionibacterium acnes and Staphylococcus epidermidis were most commonly cultured with 6 positive results for both bacteria.

Conclusions: Our study yielded a 16% false positive rate in cultures of synovial biopsy taken during primary total hip arthroplasty of healthy subjects, suggesting that contamination risk of these synovial biopsy cultures may be larger than assumed by clinicians.
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http://dx.doi.org/10.5301/hipint.5000508DOI Listing
November 2017

Accuracy of navigated cam resection in femoroacetabular impingement: A randomised controlled trial.

Int J Med Robot 2017 Dec 15;13(4). Epub 2017 Jun 15.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Background: The main cause for revision hip arthroscopy surgery is incomplete bony resection of femoroacetabular impingement (FAI). This study aimed to compare the cam resection accuracy via the conventional hip arthroscopy technique with the navigation technique.

Methods: Two prospectively randomized groups were recruited: navigated (n = 15) and conventional (n = 14). A pre-operative CT and post-operative MRI scan were obtained in all cases to compare alpha angle, range of motion simulation and determine a pre-operative 3D surgical resection plan.

Results: Post-operatively, the mean maximal alpha angle improved significantly in the navigated group compared with the conventional group (55°vs.66°; P = 0.023), especially in the 12 o' clock position (45°vs.60°; P = 0.041). However, positioning time and radiation exposure were significantly longer in the navigated group.

Conclusion: Navigated surgery is effective for patients with cam type FAI in helping restore normal anatomy, however, not without drawbacks. Larger studies will be required to validate our results.
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http://dx.doi.org/10.1002/rcs.1839DOI Listing
December 2017

Optimization of a model of out-of-hospital antibiotic therapy (OPAT) in a Belgian university hospital resulting in a proposal for national implementation.

Acta Clin Belg 2016 Oct 19;71(5):297-302. Epub 2016 May 19.

b Department of General Internal Medicine , Ghent University Hospital , Ghent , Belgium.

Objectives: Some infections require prolonged parenteral antimicrobial therapy, which can be continued in an outpatient setting. The Ghent University Hospital has 15 years of experience with Outpatient Parenteral Antimicrobial Therapy (OPAT) in the home setting of the patient.

Methods: Multidisciplinary critical approach through identification of areas for improvement with the existing OPAT process within the Ghent University Hospital. Existing literature and guidelines were used as references. An improved model is proposed for implementation.

Results: Several challenges and barriers were identified, including regulatory obstacles for OPAT in Belgium, such as lack of uniformity in ambulatory reimbursement of parenteral antimicrobials. There is no financial incentive for the patient with OPAT, as costs for the patient of outpatient therapy can be higher as compared with hospitalization. Other barriers include delayed approval of the certificate for reimbursement, low availability of medicines in the community pharmacies and limited knowledge of the medical devices for administration in ambulatory setting. All critical steps in the revised OPAT program are summarized in a flowchart with a checklist for all stakeholders. Firstly, a list with specific criteria to include patients in an OPAT program is provided. Secondly, the Multidisciplinary Infection Team received a formal mandate to review all eligible OPAT patients. In order to select the most appropriate catheter, a decision tree was developed and standardized packages with medical devices were developed. Thirdly, patients receive oral and written information about the treatment with practical and financial implications. Fourthly, information is provided toward the general practitioners, community pharmacist and home care nurse.

Conclusion: Standardization of the OPAT program aims at improving quality and safety of intravenous antimicrobial therapy in the home setting.
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http://dx.doi.org/10.1080/17843286.2016.1183285DOI Listing
October 2016

Patient-specific assessment of dysmorphism of the femoral head-neck junction: a statistical shape model approach.

Int J Med Robot 2016 Dec 8;12(4):765-772. Epub 2016 Jan 8.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Belgium.

Background: Objective quantification of anatomical variations about the femur head-neck junction in pre-operative planning for surgical intervention in femoro-acetabular impingement is problematic, as no clear definition of average normal anatomy for a specific subject exists.

Methods: We have defined the normal-equivalent of a subject's anatomy by using a statistical shape model and geometric shape optimization for finding correspondences, while excluding the femoral head-neck junction during the fitting procedure. The presented technique was evaluated on a cohort of 20 patients.

Results: Difference in α-angle measurement between the actual morphology and the predicted normal-equivalent, averaged 1.3° (SD 1.7°) in the control group versus 8° (SD 7.3°) in the patient group (p < 0.05).

Conclusions: Defining normal equivalent anatomy is effective in quantifying anatomical dysmorphism of the femoral head-neck junction and as such can improve presurgical analysis of patients diagnosed with femoro-acetabular impingement. Copyright © 2016 John Wiley & Sons, Ltd.
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http://dx.doi.org/10.1002/rcs.1726DOI Listing
December 2016

Prevalence of radiographic parameters predisposing to femoroacetabular impingement in young asymptomatic Chinese and white subjects.

J Bone Joint Surg Am 2015 Feb;97(4):310-7

Departments of Orthopaedic Surgery and Traumatology (J.V.H., H.D., C.P., and E.A.A.) and Radiology (W.H.), Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. E-mail address for E.A. Audenaert:

Background: Osteoarthritis of the hip is five to ten times more common in white people than in Chinese people. Little is known about the true prevalence of femoroacetabular impingement or its role in the development of osteoarthritis in the Chinese population. A cross-sectional study of both white and Chinese asymptomatic individuals was conducted to compare the prevalences of radiographic features posing a risk for femoroacetabular impingement in the two groups. It was hypothesized that that there would be proportional differences in hip anatomy between the white and Asian populations.

Methods: Pelvic computed tomography scans of 201 subjects (ninety-nine white Belgians and 102 Chinese; 105 men and ninety-six women) without hip pain who were eighteen to forty years of age were assessed. The original axial images were reformatted to three-dimensional pelvic models simulating standardized radiographic views. Ten radiographic parameters predisposing to femoroacetabular impingement were measured: alpha angle, anterior offset ratio, and caput-collum-diaphyseal angle on the femoral side and crossover sign, ischial spine projection, acetabular anteversion angle, center-edge angle, acetabular angle of Sharp, Tönnis angle, and anterior acetabular head index on the acetabular side.

Results: The white subjects had a less spherical femoral head than the Chinese subjects (average alpha angle, 56° compared with 50°; p<0.001). The Chinese subjects had less lateral acetabular coverage than the white subjects, with average center-edge angles of 35° and 39° (p<0.001) and acetabular angles of Sharp of 38° and 36° (p<0.001), respectively. A shallower acetabular configuration was predominantly present in Chinese women.

Conclusions: Significant differences in hip anatomy were demonstrated between young asymptomatic Chinese and white subjects. However, the absolute size of the observed differences appears to contrast with the reported low prevalence of femoroacetabular impingement in Chinese individuals compared with the high prevalence in white populations.
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http://dx.doi.org/10.2106/JBJS.M.01538DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4325085PMC
February 2015

Distinct dysregulation of the small leucine-rich repeat protein family in osteoarthritic acetabular labrum compared to articular cartilage.

Arthritis Rheumatol 2015 Feb;67(2):435-41

Objective: Articular cartilage is well studied in osteoarthritis (OA). However, the role of supporting structures, such as the acetabular labrum, a sealing structure surrounding the hip joint, has been investigated much less. We recently showed that fibrochondrocytic labrum cells are metabolically active. This study was undertaken to investigate hip OA–associated changes in human acetabular labrum cells.

Methods: Microarray analysis was performed to compare OA labrum cells to healthy labrum cells cultured in a 3-dimensional alginate bead system. Data were analyzed by cluster analysis using gene set enrichment analysis software and by gene list analysis using PANTHER gene family tools. Selected candidates were validated by quantitative polymerase chain reaction analysis on labrum and cartilage samples and by immunohistochemistry. The functional impacts of the genes identified were investigated by in vitro stimulation experiments in labrum cells.

Results: Pathway analysis revealed increased cytokine and chemokine signaling in OA labrum cells, whereas reduced extracellular matrix interactions and transforming growth factor β signaling were observed. Several genes were significantly differentially expressed in OA compared to healthy labrum. We specifically focused on 3 small leucine-rich repeat proteins (SLRPs), osteomodulin, osteoglycin, and asporin, that appeared to be distinctly regulated in OA labrum compared to OA cartilage. SLRPs were strongly down-regulated in OA labrum but up-regulated in OA articular chondrocytes. Moreover, in vitro stimulation with osteomodulin increased aggrecan expression in OA labrum cells.

Conclusion: OA labrum fibrochondrocytes have several features similar to OA chondrocytes. However, SLRP expression seems to be differentially influenced by degeneration in OA labrum compared to cartilage, suggesting a specific role for this supporting structure in OA. The functional impact of SLRPs on labrum cells makes them interesting targets for further studies in hip OA.
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http://dx.doi.org/10.1002/art.38930DOI Listing
February 2015

Histologic assessment of acetabular labrum healing.

Arthroscopy 2012 Dec 17;28(12):1784-9. Epub 2012 Oct 17.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Purpose: The purpose of this study was to histologically examine the human healing response of arthroscopically repaired acetabular labrum tears.

Methods: Biopsy specimens were retrieved from 6 patients during total hip arthroplasty after clinical failure of the index arthroscopic procedure. All patients were diagnosed as having femoroacetabular impingement with a concomitant labral tear. In all cases severe chondral damage was observed during arthroscopy (Beck grades 3 to 4). Despite successful technical repair of the labral tear, chondral damage in these patients was so advanced that the clinical progress after the procedure was unsatisfactory and arthroplasty of the joint was required. Biopsy specimens of the repaired acetabular labra were harvested during the arthroplasty surgery and processed for standard histologic evaluation.

Results: Macroscopically and histologically, all repaired labra kept their triangular shape more or less and appeared to have healed. All harvested biopsy specimens displayed a typical fibrocartilaginous appearance with limited vascular supply. Calcifications were present in only 1 biopsy specimen. In 3 cases neovascularization of the labral tissue was noticed in the proximity of the sutures. In the superficial and deep parts of the labral body, small clefts were observed in all cases.

Conclusions: In this study the histologic aspects of arthroscopically repaired human labral tears were addressed. It was shown that human labral tears show healing potential after surgical repair. The surfaces of the labral tissues were intact, and neither remnants of the tear nor the presence of fibrovascular scar tissue was observed. However, some small clefts in the superior and deep parts of the repaired structures were noticed in all cases.

Level Of Evidence: Level IV, therapeutic case series.
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http://dx.doi.org/10.1016/j.arthro.2012.06.012DOI Listing
December 2012

Early complications after revision total hip arthroplasty with cemented dual-mobility socket and reinforcement ring.

Acta Orthop Belg 2012 Jun;78(3):357-61

Department of Orthopaedic Surgery, Ghent University Hospital, Ghent, Belgium.

Encouraged by the success of dual-mobility sockets in achieving implant stability in primary hip replacement, surgeons have started to use the implant in revision hip arthroplasty. However, very little is known yet about the postoperative complication rate of this type of implant when fixation in a reinforcement ring is required. In our department, 37 dual-mobility sockets were cemented in a reinforcement ring for revision hip arthroplasty in 36 patients over a period of two years. The mean follow-up period was 16 months (range, 6-27 months). Indications for revision hip arthroplasty included, among others, recurrent dislocation (3 cases) and implant loosening (9 cases) with extensive bone loss. We observed two single re-dislocations (5.40%), one infection and one mechanical failure of the reinforcement ring; the literature mentions dislocation rates of 2.7 to 10.6% after revisions not specifically for recurrent dislocation. Revision hip arthoplasty combining dual-mobility sockets with reinforcement ring fixation thus had a relatively low early postoperative complication rate in this challenging group of patients. The design therefore seems to be a valid alternative to constrained implants, especially in high-risk revision cases. Despite the short follow-up period, cemented dual-mobility sockets seem to be a valuable option when reinforcement rings need to be used, with an acceptable dislocation rate in this challenging group of patients. But long-term survival studies are mandatory to evaluate stability and fixation longevity.
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June 2012

Range of motion in femoroacetabular impingement.

Acta Orthop Belg 2012 Jun;78(3):327-32

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Recent epidemiological studies have demonstrated that radiographic features specific to femoroacetabular impingement appear far more frequently in healthy and asymptomatic cohorts than previously anticipated. It remains unclear how incidental findings should be interpreted clinically. In addition, several authors have suggested that a decreased range of motion is part of the clinical presentation of femoroacetabular impingement. The purpose of the present study was to describe and analyze differences in range of motion between femoroacetabular impingement patients, asymptomatic individuals with incidental radiographic findings and healthy controls, using a validated electromagnetic tracking system. Furthermore, it was evaluated which motions were clinically relevant and could be used to differentiate between these three groups. We found all evaluated motions to differ significantly between patients and controls. The anterior impingement test showed a significant difference between patients and asymptomatic cases. In conclusion, functional evaluation of the range of motion appeared in this study as a useful tool in the diagnostic work-up of femoracetabular impingement.
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June 2012

Intramedullary fixation of intertrochanteric hip fractures: a comparison of two implant designs. A prospective randomised clinical trial.

Acta Orthop Belg 2012 Apr;78(2):192-8

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

We report the results of a prospective randomized clinical trial comparing the Gamma 3 nail with the ACE trochanteric nail for the treatment of pertrochanteric femoral fractures. One hundred and twelve consecutive patients were enrolled in the study: 61 patients were treated with the Gamma 3 nail, 51 with the ACE trochanteric nail. The two groups were matched for age, fracture type and preoperative Merle d'Aubigné hip score. All patients were followed up clinically and radiographically on a regular basis between 6 weeks and one year postoperatively. Twenty-six patients (23%) died within the first postoperative year. Six patients were lost to follow-up. In each group, two patients were revised due to mechanical failure. Nonunion did not occur. The mean postoperative hip scores in the Gamma 3 and the ACE group were 14.19 and 14.12 respectively, with no significant difference (p = 0.92). Walking ability was adequately restored in approximately 80% of the patients. Both implants appeared as safe and effective methods of treatment for intertrochanteric hip fractures.
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April 2012

Hip morphological characteristics and range of internal rotation in femoroacetabular impingement.

Am J Sports Med 2012 Jun 2;40(6):1329-36. Epub 2012 Apr 2.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.

Background: Radiographic features specifically related to the occurrence of femoroacetabular impingement (FAI) appear to be highly prevalent in the asymptomatic population. It remains unclear, however, how these incidental findings should be interpreted clinically and which other variables might differentiate between true incidental findings and preclinical patients.

Purpose: To study the association between cam and overall hip morphological characteristics and range of motion in impingement patients, asymptomatic patients (healthy patients with radiographic features specific to FAI), and healthy controls.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Morphological parameters describing cam and overall hip anatomy were obtained from 30 patients (10 per subgroup) with use of 3-dimensional computational methods. In addition, the range of internal rotation in high flexion activities was evaluated, and its relation to hip morphological variables was analyzed in a multivariate regression model.

Results: Size of the cam lesion and range of motion significantly differed between groups (P < .05). The range of internal rotation on impingement testing was found to average 27.9° in the healthy control group compared with 21.1° in the asymptomatic control group with radiographic features specific to FAI (P < .001) and 12.3° in the patient group (P < .001). Cam size, acetabular coverage, and femoral version appeared to be predictive variables for the range of internal rotation. Seventy-five percent of variance between patients could be attributed to the combined effect of these 3 variables (R = .86). The range of motion was decreased in cam patients and asymptomatic patients, and early femoroacetabular conflict was not restricted to the area of the cam lesion but involved the entire anterior femoral head-neck junction.

Conclusion: Decreased range of motion, as found in FAI, is not solely dependent on the size or even the occurrence of a cam lesion but should be interpreted by taking into account the overall hip anatomy, specifically femoral version and acetabular coverage. Decreased femoral anteversion and increased acetabular coverage add to the risk of early femoroacetabular collision during sports and activities of daily living and therefore appear to be additional predictive variables, besides the finding of a cam lesion, for the risk of clinical hip impingement development. In addition, the findings suggest that surgical osteochondroplasty to restore a normal range of motion may necessitate more excessive bone resection than what simply appears to be a bump on imaging.
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http://dx.doi.org/10.1177/0363546512441328DOI Listing
June 2012

Revision hip arthroplasty using a cementless modular tapered stem.

Int Orthop 2012 Jan 24;36(1):35-41. Epub 2011 Jun 24.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Purpose: Here we report the short-term clinical and radiological results of the Profemur®-R cementless modular revision stem.

Methods: Between June 2002 and May 2006, 68 revision hip arthroplasties were consecutively performed using this stem. Survival at a mean follow-up of 5.2 years was 94%. According to the Paprosky classification, the femoral defect was classified as type 1 in 39 hips (57.3%), type 2 in 18 hips (26.5%), type 3A in ten hips (14.7%) and type 3B in one hip (1.5%).

Results: The Harris Hip Score was 49.57 before surgery and averaged 78.28 at the latest follow-up. The Merle d'Aubigne score improved from 9.15 preoperatively to 14.30 postoperatively. Stem stability rated according to the Agora Roentgenographic Assessment (ARA) scoring system averaged 5.22, suggesting a high likelihood of a durable implant.

Conclusion: The revision prosthesis examined in this study can be considered a viable and useful option in revision hip arthroplasty, even in patients with bony femoral defects.
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http://dx.doi.org/10.1007/s00264-011-1299-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251668PMC
January 2012

Can we predict the natural course of femoroacetabular impingement?

Acta Orthop Belg 2011 Apr;77(2):188-96

Department of Orthopaedic Surgery, Physical Medicine and Rehabilitation, Gent University Hospital, De Pintelaan 185, 9000 Gent, Belgium.

We conducted a multivariate regression analysis (including both radiographic and activity related variables) in patients with osteoarthritis of the hip and structural changes related with femoroacetabular impingement. The purpose of this study was to investigate whether the age at which total hip arthroplasty may have to be performed, can be predicted in patients with femoroacetabular impingement (FAI). In 121 patients with FAI-related osteoarthritis, radiographic variables describing FAI-related parameters were obtained and the patients were questioned about their activity during early adulthood by means of the validated Baecke et al questionnaire. None of the variables significantly correlated with the final outcome parameter : age at surgery. As expected, based on the low correlation ratios of the different parameters investigated, a multiple-regression model was not accurate enough to allow any prediction on the natural course of FAI. We found that it is difficult to accurately predict the age at which a patient with FAI will develop early osteoarthritis. From our findings it appears that a hip with FAI is not always prone to early end-stage osteoarthritic degeneration, not even in patients with a high level of physical activity. Hence, considering the high prevalence of FAI-related radiographic findings, we conclude that not every radiographic abnormality requires treatment.
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April 2011

Preformed gentamicin spacers in two-stage revision hip arthroplasty: functional results and complications.

Int Orthop 2011 Oct 30;35(10):1471-6. Epub 2010 Nov 30.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185 - P5, 9000, Ghent, Belgium.

Two-stage revisions with antibiotic-loaded spacers have gained popularity for treating infected hip-joint arthroplasties. The aim of this prospective study was to assess patient functionality between stages and treatment impact on duration of hospital stay and to describe related complications. Sixty-one consecutive patients with infected hip arthroplasties underwent two-stage revision with preformed spacer implantation. Mean Harris Hip and Merle d'Aubigné scores between the two stages were 39.9 and 7.6, respectively. Forty-six patients (75.4%) were able to leave hospital between stages. Spacer dislocation occurred in 16.4%. No cases of spacer breakage were noted. Preformed cement spacers provide acceptable functional outcome between revision hip arthroplasty stages and facilitate the surgical procedure without increasing mechanical complication rates.
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http://dx.doi.org/10.1007/s00264-010-1172-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174299PMC
October 2011

Three-dimensional assessment of cam engagement in femoroacetabular impingement.

Arthroscopy 2011 Feb 16;27(2):167-71. Epub 2010 Oct 16.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Purpose: The purpose of our study was to 3-dimensionally assess cam engagement in male patients with symptomatic femoroacetabular impingement during motion.

Methods: A total of 13 hips with cam-type impingement were investigated. Patient anatomy and clinical range of motion were determined. After 3-dimensional segmentation and reconstruction, the dynamic behavior of the cam lesion was investigated for the previously analyzed motions.

Results: Important differences in the pattern of cam engagement were noticed. Abutment of the cam lesion and the acetabular cartilage was observed in flexion in 7 hips (54%) and in abduction in 11 hips (84%). Internal rotation with the hip in 90° of flexion caused intrusion of the cam lesion into the joint in 10 of the investigated cases (77%). Neutral rotation did not cause any conflict between the cam lesion and acetabulum for the measured range of motion. A similar area in the anterosuperior quadrant of the acetabulum appeared to be involved in the different motions that were analyzed.

Conclusions: Typically, during internal rotation in 90° of flexion, the centromedial portion of the cam lesion was found to abut against the anterosuperior quadrant of the acetabular cartilage. During abduction and flexion, this appeared to be the lateral and medial portions of the cam lesion, respectively. All motions causing cam intrusion appeared to focus on the same cartilage area of the acetabulum in its anterosuperior quadrant.
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http://dx.doi.org/10.1016/j.arthro.2010.06.031DOI Listing
February 2011

Development of a three-dimensional detection method of cam deformities in femoroacetabular impingement.

Skeletal Radiol 2011 Jul 18;40(7):921-7. Epub 2010 Aug 18.

Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.

Objective: The description of femoral head sphericity and related risk for femoroacetabularimpingement is currently limited to an angular estimate-the alpha angle-whose relevance and accuracy have been challenged. We developed a three-dimensional approach for both automated digital measurement of the alpha angle and the detection of camdeformities. Accuracy and diagnostic relevance of the alpha angle estimated by means of the oblique axial and multiple radial plane protocol were compared with the computed results.

Materials And Methods: Using subject-specific statistical information of the femur head and mid-neck region, a method was developed to accurately compute the maximum alpha angle and to define aspherical eccentric areas at the femoral head-neck junction. The method was evaluated on 102 dry cadaver femur specimens.

Results: Average detection limit for bony prominences at the head-neck transition was 0.98 mm. Pixel size of the investigated CT data was 0.79 mm. Mean maximum computed alpha angle of the femurs with cam-type morphology as identified by the morphological method was 67.72° (range 53.04-88.02°). Mean maximum computed alpha angle of the femurs without cam deformity was 47.65° (range 38.67-59.81°). Alpha angle estimates obtained by means of the multiple radial plane protocol correlated better (R = 0.88) and showed higher diagnostic agreement (phi = 0.77) with the 3D computational analysis compared to the oblique axial protocol (R = 0.60; phi = 0.67).

Conclusions: The alpha angle seems to be a relevant screening tool when obtained by 3D computed analysis or when estimated according to the multiple radial plane protocol. Estimates obtained by means of the oblique axial protocol have insufficient diagnostic and measurement accuracy.
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http://dx.doi.org/10.1007/s00256-010-1021-2DOI Listing
July 2011

Whole blood metal ion concentrations in correlation with activity level in three different metal-on-metal bearings.

J Arthroplasty 2011 Jan 19;26(1):58-64. Epub 2010 Feb 19.

Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Seventy consecutive osteoarthritis patients younger than 65 years undergoing a hip arthroplasty were included. Three different metal bearings were used (2 different resurfacing systems and one 28-mm metal bearing) and compared with a ceramic control group. Whole blood cobalt and chromium levels were analyzed preoperatively, at 3 months, 6 months, 1 year, and 2 years. Patients with steep cups (abduction >55°) were excluded. No significant differences in functional scores and activity level were found between either groups. Ion levels were significantly lower with one type of resurfacing. No correlation was found between ion and activity level. In conclusion, although the current second-generation metal bearings may show differences in ion release, more attention should be paid to the correlation between ion release and implant positioning.
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http://dx.doi.org/10.1016/j.arth.2009.11.007DOI Listing
January 2011

Balloon dissection for improved access to the peritrochanteric compartment.

Arthroscopy 2009 Nov;25(11):1349-53

Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.

Nonarthritic, trochanteric pain is a commonly encountered orthopaedic condition. Although most patients respond to conservative treatment, those with recalcitrant symptoms may require surgical intervention. Studies have successfully explored the use of the arthroscope in the treatment of these patients. We report a new technique for an arthroscopic approach to the peritrochanteric space. Our technique involves the use of a balloon trocar for fast and improved dissection and visualization of the peritrochanteric compartment in hip arthroscopy.
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http://dx.doi.org/10.1016/j.arthro.2009.06.020DOI Listing
November 2009

Complications encountered with the use of constrained acetabular prostheses in total hip arthroplasty.

J Arthroplasty 2010 Feb 4;25(2):287-94. Epub 2008 Dec 4.

Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Gent, Belgium.

At our department, 46 constrained acetabular components in 38 patients were placed successively for a period of 4 years. Indications included recurrent dislocation, septic and aseptic loosening with extensive bone loss, tumor surgery with extensive bone resection, and instability due to neurologic impairment. Because 2 cup failures and 10 dislocations were observed with the constrained devices at 4 to 7 years of follow-up, the authors started to use large-diameter metal-on-metal bearings for similar indications. A series of 36 such bearings in 38 patients revealed only one cup failure and one dislocation at 2 to 4 years of follow-up. Although the 2 series are different and therefore difficult to compare, the authors recommend judicious use of constrained devices because of the high failure rate (26%) and consideration of alternative options such as the use of large-diameter metal-on-metal bearings.
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http://dx.doi.org/10.1016/j.arth.2008.10.010DOI Listing
February 2010

Does intraoperative cell salvage remove cobalt and chromium from reinfused blood?

J Arthroplasty 2009 Oct 11;24(7):1125-9. Epub 2008 Sep 11.

Anca Medical Centre Ghent, Belgium.

In 12 patients undergoing a revision hip arthroplasty after a failed metal-on-metal primary hip arthroplasty, the effectiveness of intraoperative cell salvage (ICS) in removing metal ions was investigated. Samples of blood collected during surgery were filtered using 2 ICS devices. The samples had the concentrations of cobalt (Co) and chromium (Cr) measured before and after filtration. There was an average reduction of 76.3% for Cr concentration and 78.6% for Co concentration after ICS filtering. The Co-to-Cr ratio before and after filtration was similar. At the present time, these salvage systems should be used with caution in the patient undergoing revision of metal-on-metal bearing surfaces.
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http://dx.doi.org/10.1016/j.arth.2008.06.019DOI Listing
October 2009
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