Archives des Hip - Dr Majed Issa https://drmajedissa.com/en/category/hip-en/ Chirurgien Orthopédique et Traumatologue Thu, 08 Feb 2024 11:45:28 +0000 en-GB hourly 1 https://wordpress.org/?v=6.9.4 https://drmajedissa.com/wp-content/uploads/2021/10/cropped-Logo-docteur-majed-issa-bleu-e1690128320683-32x32.png Archives des Hip - Dr Majed Issa https://drmajedissa.com/en/category/hip-en/ 32 32 TOTAL HIP REPLACEMENT https://drmajedissa.com/en/total-hip-replacement/ Tue, 06 Feb 2024 15:34:30 +0000 https://drmajedissa.com/?p=9308 Total hip replacement or THR is one of the most commonly performed surgeries in France, with about 130,000 primary procedures performed each year. The two main indications for such surgery are displaced femoral neck fractures and hip osteoarthritis (coxarthrosis), which generally occurs after the age of 60. In younger patients, several other pathologies can lead to such surgery: dysplasia, rheumatoid arthritis, avascular necrosis, advanced femoroacetabular impingement, etc. In the case of hip osteoarthritis, the eroded and dried-out cartilage can no longer ensure frictionless sliding of the joint surfaces. The contact of the bare bones during joint movement becomes increasingly painful and stiffening. DEFINITION OF A THR: Joint replacement with a prosthesis involves the excision of damaged joint surfaces and the installation of new, smooth, and painless artificial surfaces, accurately replicating the morphology and mobility of a native hip. Preparation for the surgery: Preparation of the general medical condition is essential before the surgery, including: A cardiological assessment: Your cardiologist must evaluate your cardiac condition and certify the absence of contraindications to surgery. A dental check-up: Your dentist must certify the absence of a dental infection. If you are diabetic, your diabetes must be well-controlled. Poorly managed diabetes increases the risk of infection and healing problems. Verification of the absence of latent infection in your body, notably urinary tract infection. A general blood test. This will be followed by a consultation with the anesthesiologist, who will analyze all these elements and propose the type of anesthesia according to your needs: General anesthesia (you are completely asleep throughout the surgery) or spinal anesthesia (injection in the back similar to an epidural, only the lower body is anesthetized). Each anesthesia method has its advantages. If you prefer not to see, hear, or feel anything, general anesthesia is ideal for you. If you are apprehensive about falling asleep and prefer to maintain a sense of “control” over the situation, you can request spinal anesthesia. Hip replacement cannot be performed under pure local anesthesia. Surgical planning: We perform a digital planning or use templates for the prosthesis beforehand. This involves determining in advance the sizes and shapes of implants that match the patient’s anatomy and allowing for a faithful reproduction of the movements and anatomy of the native joint (range of motion, length of the lower limb, appropriate tension of tissues, especially the muscular sling of the gluteals). In cases where the femoral or acetabular anatomy is unusual, it is necessary to perform a 3D planning of the prosthesis. Moreover, we have the possibility to simulate the range of motion of the planned prosthesis, and to adjust precisely the position of each implant in the three planes of space to optimize this range to the maximum and avoid potential mechanical conflicts. 3D printing has also been helpful in planning certain difficult cases of hip dysplasia or revision THR. The surgery: The surgery typically lasts one hour. This duration can vary depending on the complexity of the case. You are laid on your back on a specialized table that allows for the mobilization of the operated hip in all planes of space. The surgical approach: Several surgical approaches are available for performing a Total Hip Replacement (THR). Statistically, the most commonly used approach in France is the posterior approach (Moore’s approach), which requires cutting through the gluteus maximus muscle and some of the pelvitrochanteric muscles to access the joint. It provides easy access to the joint and allows for extension to the femoral diaphysis if needed, but it has a slightly higher dislocation rate and a slightly longer functional recovery than other approaches. We have chosen to use Moore’s posterior approach only for difficult prosthesis changes (difficult THR revisions) and situations where a mini-invasive anterior approach would be contraindicated. Indeed, we perform the majority of our hip prostheses through a mini-invasive anterior approach. This approach was described by the German C. Hueter and then developed by R. Judet, M. Siguier, and E. Letournel in France (three pioneers of orthopedic surgery in the world). It allows access to the hip without cutting through muscles. The skin incision is on average 10cm and is located at the front of the proximal thigh. For such surgery, this is considered a small incision. But what truly makes the anterior approach “mini-invasive” is the preservation of deep structures, especially the muscles. At each depth level, muscles are successively pushed aside to reach the anterior face of the hip joint. Once the joint procedure is completed and the prosthesis placed, the retractors are removed, and the muscles naturally return to their anatomical position. There is no need for muscle suturing. Postoperative follow-up: Once the surgery is completed, you are transferred to the recovery room, where you gradually wake up from the anesthesia under the watchful eyes of the nursing staff. A control X-ray is systematically requested and shown to the surgeon to verify the position of the implants once again. You stay in the recovery room for an average of one to three hours, then a porter takes you back to your room. I visit you with the nurses at the end of the day to give you post-operative instructions, but also to help you walk. The quick and relatively painless recovery is one of the main advantages of the mini-invasive anterior approach, and the majority of our patients manage to stand up and take a few steps in the corridor on the evening of the surgery. Even though they are allowed full weight-bearing on both legs, I strongly recommend my patients walk with two crutches for at least two weeks. This serves as protection against false movements and slips while they regain perfect control of all movements. The next morning, a physiotherapist visits you. They help you walk, teach you how to use crutches, and have you practice a few stair steps. If you are comfortable enough walking and your control blood test is good, discharge can be authorized. The majority of our patients manage to return home the day after

L’article TOTAL HIP REPLACEMENT est apparu en premier sur Dr Majed Issa.

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Total hip replacement or THR is one of the most commonly performed surgeries in France, with about 130,000 primary procedures performed each year.

The two main indications for such surgery are displaced femoral neck fractures and hip osteoarthritis (coxarthrosis), which generally occurs after the age of 60.

In younger patients, several other pathologies can lead to such surgery: dysplasia, rheumatoid arthritis, avascular necrosis, advanced femoroacetabular impingement, etc.

In the case of hip osteoarthritis, the eroded and dried-out cartilage can no longer ensure frictionless sliding of the joint surfaces. The contact of the bare bones during joint movement becomes increasingly painful and stiffening.

DEFINITION OF A THR:

Joint replacement with a prosthesis involves the excision of damaged joint surfaces and the installation of new, smooth, and painless artificial surfaces, accurately replicating the morphology and mobility of a native hip.

Preparation for the surgery:

Preparation of the general medical condition is essential before the surgery, including:

  1. A cardiological assessment: Your cardiologist must evaluate your cardiac condition and certify the absence of contraindications to surgery.
  2. A dental check-up: Your dentist must certify the absence of a dental infection.
  3. If you are diabetic, your diabetes must be well-controlled. Poorly managed diabetes increases the risk of infection and healing problems.
  4. Verification of the absence of latent infection in your body, notably urinary tract infection.
  5. A general blood test.

This will be followed by a consultation with the anesthesiologist, who will analyze all these elements and propose the type of anesthesia according to your needs: General anesthesia (you are completely asleep throughout the surgery) or spinal anesthesia (injection in the back similar to an epidural, only the lower body is anesthetized). Each anesthesia method has its advantages.

If you prefer not to see, hear, or feel anything, general anesthesia is ideal for you. If you are apprehensive about falling asleep and prefer to maintain a sense of “control” over the situation, you can request spinal anesthesia. Hip replacement cannot be performed under pure local anesthesia.

Surgical planning:

We perform a digital planning or use templates for the prosthesis beforehand. This involves determining in advance the sizes and shapes of implants that match the patient’s anatomy and allowing for a faithful reproduction of the movements and anatomy of the native joint (range of motion, length of the lower limb, appropriate tension of tissues, especially the muscular sling of the gluteals).

In cases where the femoral or acetabular anatomy is unusual, it is necessary to perform a 3D planning of the prosthesis.

Moreover, we have the possibility to simulate the range of motion of the planned prosthesis, and to adjust precisely the position of each implant in the three planes of space to optimize this range to the maximum and avoid potential mechanical conflicts. 3D printing has also been helpful in planning certain difficult cases of hip dysplasia or revision THR.

The surgery:

The surgery typically lasts one hour. This duration can vary depending on the complexity of the case.

You are laid on your back on a specialized table that allows for the mobilization of the operated hip in all planes of space.

The surgical approach:

Several surgical approaches are available for performing a Total Hip Replacement (THR). Statistically, the most commonly used approach in France is the posterior approach (Moore’s approach), which requires cutting through the gluteus maximus muscle and some of the pelvitrochanteric muscles to access the joint. It provides easy access to the joint and allows for extension to the femoral diaphysis if needed, but it has a slightly higher dislocation rate and a slightly longer functional recovery than other approaches.

We have chosen to use Moore’s posterior approach only for difficult prosthesis changes (difficult THR revisions) and situations where a mini-invasive anterior approach would be contraindicated. Indeed, we perform the majority of our hip prostheses through a mini-invasive anterior approach.

This approach was described by the German C. Hueter and then developed by R. Judet, M. Siguier, and E. Letournel in France (three pioneers of orthopedic surgery in the world). It allows access to the hip without cutting through muscles. The skin incision is on average 10cm and is located at the front of the proximal thigh.

For such surgery, this is considered a small incision. But what truly makes the anterior approach “mini-invasive” is the preservation of deep structures, especially the muscles. At each depth level, muscles are successively pushed aside to reach the anterior face of the hip joint.

Once the joint procedure is completed and the prosthesis placed, the retractors are removed, and the muscles naturally return to their anatomical position. There is no need for muscle suturing.

Postoperative follow-up:

Once the surgery is completed, you are transferred to the recovery room, where you gradually wake up from the anesthesia under the watchful eyes of the nursing staff. A control X-ray is systematically requested and shown to the surgeon to verify the position of the implants once again.

You stay in the recovery room for an average of one to three hours, then a porter takes you back to your room. I visit you with the nurses at the end of the day to give you post-operative instructions, but also to help you walk.

The quick and relatively painless recovery is one of the main advantages of the mini-invasive anterior approach, and the majority of our patients manage to stand up and take a few steps in the corridor on the evening of the surgery. Even though they are allowed full weight-bearing on both legs, I strongly recommend my patients walk with two crutches for at least two weeks. This serves as protection against false movements and slips while they regain perfect control of all movements.

The next morning, a physiotherapist visits you. They help you walk, teach you how to use crutches, and have you practice a few stair steps. If you are comfortable enough walking and your control blood test is good, discharge can be authorized. The majority of our patients manage to return home the day after the surgery. Post-operative pain is generally well controlled by the prescribed medication and significantly diminishes starting from the 2nd week.

A daily injection of anticoagulants for 4 to 6 weeks reduces the risk of post-operative thrombophlebitis. Rehabilitation during the first two months following a THR is quite straightforward: You should walk, at your own pace, gradually increasing the distance and frequency each day, to gradually get your muscles, which have suffered for years from arthritic disease, back in shape.

If needed, exercises and rehabilitation sessions will follow with a physiotherapist, beyond the first two months.

Prothèse totale de la hanche gauche. La prothèse est fabriquée à partir d'un alliage de Chrome-Cobalt ou de Titane
Prothèse totale de la hanche gauche. La prothèse est fabriquée à partir d'un alliage de Chrome-Cobalt ou de Titane
La mobilité du patient est radicalement améliorée!
La mobilité du patient est radicalement améliorée!
Parfois l'articulation est tellement détruite par l'arthrose qu'une reconstruction osseuse est nécessaire.
Parfois l'articulation est tellement détruite par l'arthrose qu'une reconstruction osseuse est nécessaire.
Radiographie après reconstruction du cotyle pour restituer le centre de rotation de l'articulation
Radiographie après reconstruction du cotyle pour restituer le centre de rotation de l'articulation

Here is a photo of a scar from an anterior approach, it averages 10cm in length.

L’article TOTAL HIP REPLACEMENT est apparu en premier sur Dr Majed Issa.

]]> THE FEMORAL NECK FRACTURE https://drmajedissa.com/en/the-femoral-neck-fracture/ Tue, 06 Feb 2024 15:13:16 +0000 https://drmajedissa.com/?p=9302 The femoral neck fracture is one of the most common fractures in trauma surgery. Each year, most often due to a simple fall, more than 80,000 people, a majority of whom are women over 70 years old, fall victim to it. The treatment for these fractures is surgical in almost all cases. The femur forms the skeleton of the thigh; its upper end, the femoral head, which is spherical in shape, articulates with the pelvis. It is connected to the body of the femur, the diaphysis, by the femoral neck. This neck is shaped like a very strong flying buttress but works in cantilever and bears the entire weight of the body while standing, walking, and in all acts performed while bearing weight on the lower limb. The risk of fracture increases with age: The femoral neck fracture can affect adults of any age following a violent accident (scooter, motorcycle, car, sports, etc.), or at lower velocity among the elderly (20 to 30 times more than in young adults). Indeed, the femoral neck, like other parts of the skeleton, becomes more fragile with age due to decreased bone density. In severe cases, this is referred to as osteoporosis. This is exacerbated by sedentary lifestyle or certain treatments (e.g., long-term high-dose cortisone), and affects women twice as much after menopause as it does men. In the elderly, the risk of falling and therefore of fracture can be increased by a multitude of medical and non-medical factors: Visual disorders (AMD, loss of visual acuity, etc.) Balance disorders (inner ear problems, vertigo, etc.) Loss of muscle strength (sarcopenia) Neurological disorders (consequences of stroke, tumors, etc.) Certain medications (opioid derivatives, tranquilizers, antihypertensives, etc.) Insufficient fall prevention: wet floors, poorly lit rooms, carpet edges, etc. Two types of fractures: There are two main types of femoral neck fractures according to their location: ➜ “True cervical” fractures that affect the neck itself (1/3 of fractures)  ➜ Pertrochanteric fractures (2/3 of femoral neck fractures) located at the junction between the neck and the diaphysis. Fracture cervicale Fracture per-trochantérienne An emergency situation: In most cases, the patient has total functional impotence: they are unable to get up or walk. They experience very severe pain at the hip level (groin fold, buttocks). Most often, there is a shortening and external rotation of the lower limb. Emergency hospitalization is necessary to confirm the diagnosis with radiographs, sometimes a CT scan if needed. In the case of some true cervical fractures where the neck is embedded in the femoral head without detaching, the pain is less, which can be misleading. Therefore, in the slightest suspicion of a femoral neck fracture, the patient is immobilized in principle, until a precise radiological diagnosis is obtained, to avoid worsening an initially good prognosis fracture. Two types of surgery: Surgery is almost always performed after a femoral neck fracture, except in cases of major contraindications in some patients whose health is very deteriorated (less than 1 case out of 100). The surgery must be carried out very quickly after the accident to give the patient the best chances of recovery and to limit the medical risks associated with prolonged bed rest (urinary infection, pneumonia, bedsores, etc.). Displaced true cervical fractures Pertrochanteric fractures ➜ In displaced true cervical fractures, the microvessels supplying blood to the femoral head have likely been ruptured at the time of the fracture. The risks of necrosis of the head (death of bone cells) or non-union (called pseudarthrosis) are significant. In elderly subjects, we prefer to solve the problem once and for all, and therefore often opt for prosthetic replacement of the joint (intermediate or total hip prosthesis). In the specific case of very young patients or in cases of non-displaced true cervical fractures, osteosynthesis with percutaneous screws or intramedullary nailing is worth attempting, in the hope of sufficient restoration of blood supply and thus a “revitalization” of the native femoral head after the fracture. ➜ In pertrochanteric fractures, the microvessels ensuring blood supply to the femoral head have probably not been affected by the fracture. The fracture is distant from their anatomical emergence point. Therefore, these fractures are most often reduced and stabilized by osteosynthesis (intramedullary nail or screw-plate). Displaced true cervical fractures Pertrochanteric fractures ➜ In displaced true cervical fractures, the microvessels irrigating the femoral head have likely been ruptured at the time of the fracture. The risks of head necrosis (death of bone cells) or non-union (called pseudarthrosis) are significant. In elderly subjects, we prefer to solve the problem once and for all, and therefore often opt for prosthetic replacement of the joint (either a hemiarthroplasty or total hip prosthesis). In the specific case of very young patients or in cases of non-displaced true cervical fractures, osteosynthesis with percutaneous screws or an intramedullary nail is worth attempting, in the hope of sufficient restoration of blood supply and thus a “revitalization” of the native femoral head after the fracture. ➜ In pertrochanteric fractures, the microvessels ensuring the blood supply to the femoral head have probably not been affected by the fracture. The fracture is distant from their anatomical emergence point. Therefore, these fractures are most often reduced and stabilized by osteosynthesis (intramedullary nail or screw-plate). Prothèse partielle ou intermédiaire: Seul le versant fémoral est remplacé Prothèse totale: Le versant fémoral et cotyloidien sont remplacés Vissage percutané d’une fracture non déplacée du col fémoral Ostéosynthèse d’une fracture per-trochantérienne par clou gamma The primary goal of surgery in elderly patients is to enable them to stand and walk as soon as possible with full support. Early complications: (surgical site infection, pulmonary embolism, etc.) are rare but can be serious. Late complications: nonunion (lack of fracture healing), avascular necrosis of the femoral head, and prosthesis loosening often require re-intervention. The most serious complication of femoral neck fractures in old age is the progressive post-operative deterioration of the general condition with decompensation of preexisting diseases. In rare cases where the patient cannot undergo surgery for medical reasons, a non-surgical treatment can be performed

L’article THE FEMORAL NECK FRACTURE est apparu en premier sur Dr Majed Issa.

]]>

The femoral neck fracture is one of the most common fractures in trauma surgery. Each year, most often due to a simple fall, more than 80,000 people, a majority of whom are women over 70 years old, fall victim to it. The treatment for these fractures is surgical in almost all cases.

The femur forms the skeleton of the thigh; its upper end, the femoral head, which is spherical in shape, articulates with the pelvis. It is connected to the body of the femur, the diaphysis, by the femoral neck. This neck is shaped like a very strong flying buttress but works in cantilever and bears the entire weight of the body while standing, walking, and in all acts performed while bearing weight on the lower limb.

The risk of fracture increases with age:

The femoral neck fracture can affect adults of any age following a violent accident (scooter, motorcycle, car, sports, etc.), or at lower velocity among the elderly (20 to 30 times more than in young adults).

Indeed, the femoral neck, like other parts of the skeleton, becomes more fragile with age due to decreased bone density. In severe cases, this is referred to as osteoporosis. This is exacerbated by sedentary lifestyle or certain treatments (e.g., long-term high-dose cortisone), and affects women twice as much after menopause as it does men.

In the elderly, the risk of falling and therefore of fracture can be increased by a multitude of medical and non-medical factors:

  1. Visual disorders (AMD, loss of visual acuity, etc.)
  2. Balance disorders (inner ear problems, vertigo, etc.)
  3. Loss of muscle strength (sarcopenia)
  4. Neurological disorders (consequences of stroke, tumors, etc.)
  5. Certain medications (opioid derivatives, tranquilizers, antihypertensives, etc.)
  6. Insufficient fall prevention: wet floors, poorly lit rooms, carpet edges, etc.

Two types of fractures:

There are two main types of femoral neck fractures according to their location:

➜ “True cervical” fractures that affect the neck itself (1/3 of fractures)

 ➜ Pertrochanteric fractures (2/3 of femoral neck fractures) located at the junction between the neck and the diaphysis.

garden-570x422
Fracture cervicale
Fracture per-trochantérienne

An emergency situation:

In most cases, the patient has total functional impotence: they are unable to get up or walk. They experience very severe pain at the hip level (groin fold, buttocks). Most often, there is a shortening and external rotation of the lower limb.

Emergency hospitalization is necessary to confirm the diagnosis with radiographs, sometimes a CT scan if needed.

In the case of some true cervical fractures where the neck is embedded in the femoral head without detaching, the pain is less, which can be misleading. Therefore, in the slightest suspicion of a femoral neck fracture, the patient is immobilized in principle, until a precise radiological diagnosis is obtained, to avoid worsening an initially good prognosis fracture.

Two types of surgery:

Surgery is almost always performed after a femoral neck fracture, except in cases of major contraindications in some patients whose health is very deteriorated (less than 1 case out of 100).

The surgery must be carried out very quickly after the accident to give the patient the best chances of recovery and to limit the medical risks associated with prolonged bed rest (urinary infection, pneumonia, bedsores, etc.).

Displaced true cervical fractures
Pertrochanteric fractures

➜ In displaced true cervical fractures, the microvessels supplying blood to the femoral head have likely been ruptured at the time of the fracture. The risks of necrosis of the head (death of bone cells) or non-union (called pseudarthrosis) are significant.

In elderly subjects, we prefer to solve the problem once and for all, and therefore often opt for prosthetic replacement of the joint (intermediate or total hip prosthesis).

In the specific case of very young patients or in cases of non-displaced true cervical fractures, osteosynthesis with percutaneous screws or intramedullary nailing is worth attempting, in the hope of sufficient restoration of blood supply and thus a "revitalization" of the native femoral head after the fracture.

➜ In pertrochanteric fractures, the microvessels ensuring blood supply to the femoral head have probably not been affected by the fracture. The fracture is distant from their anatomical emergence point.

Therefore, these fractures are most often reduced and stabilized by osteosynthesis (intramedullary nail or screw-plate).

Displaced true cervical fractures

Pertrochanteric fractures

➜ In displaced true cervical fractures, the microvessels irrigating the femoral head have likely been ruptured at the time of the fracture. The risks of head necrosis (death of bone cells) or non-union (called pseudarthrosis) are significant.

In elderly subjects, we prefer to solve the problem once and for all, and therefore often opt for prosthetic replacement of the joint (either a hemiarthroplasty or total hip prosthesis).

In the specific case of very young patients or in cases of non-displaced true cervical fractures, osteosynthesis with percutaneous screws or an intramedullary nail is worth attempting, in the hope of sufficient restoration of blood supply and thus a "revitalization" of the native femoral head after the fracture.

➜ In pertrochanteric fractures, the microvessels ensuring the blood supply to the femoral head have probably not been affected by the fracture. The fracture is distant from their anatomical emergence point.

Therefore, these fractures are most often reduced and stabilized by osteosynthesis (intramedullary nail or screw-plate).

Prothèse partielle ou intermédiaire: Seul le versant fémoral est remplacé
Prothèse partielle ou intermédiaire: Seul le versant fémoral est remplacé
Prothèse totale: Le versant fémoral et cotyloidien sont remplacés
Prothèse totale: Le versant fémoral et cotyloidien sont remplacés
Vissage percutané d'une fracture non déplacée du col fémoral
Vissage percutané d'une fracture non déplacée du col fémoral
Ostéosynthèse d'une fracture per-trochantérienne par clou gamma
Ostéosynthèse d'une fracture per-trochantérienne par clou gamma

The primary goal of surgery in elderly patients is to enable them to stand and walk as soon as possible with full support.

Early complications: (surgical site infection, pulmonary embolism, etc.) are rare but can be serious.

Late complications: nonunion (lack of fracture healing), avascular necrosis of the femoral head, and prosthesis loosening often require re-intervention.

The most serious complication of femoral neck fractures in old age is the progressive post-operative deterioration of the general condition with decompensation of preexisting diseases.

In rare cases where the patient cannot undergo surgery for medical reasons, a non-surgical treatment can be performed (continuous traction of the fractured limb until consolidation) but the complications related to bed rest in an already very fragile patient are often very serious.

After the surgery:

Rehabilitation is essential after the surgery. Its duration varies according to the patient’s age and their ability to recover. It starts the day after the operation in the orthopedic and trauma surgery department and primarily consists of getting the patient to walk and gently maintaining their joint mobility.

Rehabilitation is often lengthy for elderly patients who must not only relearn to walk but also regain their independence in daily life activities (sitting, lying down, getting out of bed, bathing, etc.). Hence, the need for appropriate care after the hospital stay: either by a physiotherapist at home in the best cases, or more often, in a convalescence center or a functional rehabilitation service.

Bone consolidation of the fracture is generally achieved within six to eight weeks, justifying prolonged use of canes. In the case of a prosthesis, the hip can be immediately loaded, allowing for a quicker recovery.

Ultimately, the patient will be able to walk again, preferably with a walker (or crutches) to avoid another fall.

It’s important to know that even in the absence of complications, a femoral neck fracture often results in some partial loss of independence in elderly patients.

After 80-85 years, and for patients living alone, the femoral neck fracture is one of the most frequent reasons for admission into a nursing home.

On the other hand, a young adult, quickly autonomous with their crutches, will return home after a short hospital stay and will regain their functional abilities once the fracture has consolidated.

Here are some prevention tips:

In addition to adapting one’s home to eliminate objects on the floor that could cause a fall, the first piece of advice is to stay active. It is strongly recommended to walk every day, which helps to strengthen bone density and maintain good muscle quality.

For the same reason, it is important to have a good nutritional balance with sufficient intake of proteins and calcium. After menopause, women should also monitor their bone mineralization with exams and, in case of mineral deficiency, take appropriate supplementation.

To learn more about the care of elderly patients suffering from a hip fracture, you can consult the article published by the Haute Autorité de Santé by clicking on the following link:

(https://www.has-sante.fr/portail/jcms/c_2803118/fr/fracture-de-la-hanche-optimiser-la-prise-en-charge-des-patients-ages)

Adapted from the information sheet of SOFCOT (French Society of Orthopedic and Traumatological Surgery)

L’article THE FEMORAL NECK FRACTURE est apparu en premier sur Dr Majed Issa.

]]> HIP ARTHROSCOPY https://drmajedissa.com/en/hip-arthroscopy/ Tue, 06 Feb 2024 14:37:07 +0000 https://drmajedissa.com/?p=9296 Hip arthroscopy is a recent technique, developing rapidly over the past fifteen years, allowing for the repair of the joint when it is not yet too damaged. Thus, it is part of the treatments that preserve the native hip. Indeed, we are increasingly realizing that at least 40% of hip osteoarthritis could be due to untreated old lesions or small anatomical defects leading to the slow and progressive destruction of the joint. Hip-preserving surgery, notably arthroscopy, allows for the repair of these lesions and anatomical defects in patients before the joint damage becomes irreversible and hip replacement becomes the only remaining solution. Arthroscopy involves the insertion of a camera and thin instruments into the joint to perform a surgical intervention without tissue destruction. There is no muscle cutting, and the scars are pinpoint. This process, therefore, allows for a quicker recovery, which is why arthroscopies are most often performed on an outpatient basis. What pathologies can be treated with hip arthroscopy? 1) Femoroacetabular Impingement (FAI): This is a dynamic pathology, characterized by the abnormal contact of the femoral neck against the rim of the acetabulum during hip flexion and rotation. The labrum and the cartilage on this rim are repeatedly crushed, leading to their fissuring. This contact can originate either from the presence of a bone bump on the femoral neck (cam effect), or from a too prominent acetabular rim (pincer or clamp effect). The combination of both deformities is common, referred to as a mixed impingement. Certain sports requiring large ranges of motion are particularly prone to impingements, such as combat sports, classical dance, ballet, etc. Some professions are also predisposed, especially those requiring squatting on the ground (e.g., tilers, mechanics), or extreme prolonged or repetitive hip flexion (e.g., taxi drivers). The procedure involves shaving the bone areas causing the impingement, at the level of the femur and/or the acetabulum, using a motorized arthroscopic burr. It is often also necessary to repair sequela lesions of the impingement, such as tears of the labrum or cartilage. 2) Labral lesions The labrum is an elastic joint attached to the periphery of the acetabulum, which ensures the tightness and stability of the hip. It has the same consistency as a meniscus in the knee, somewhat like soft rubber. Its lesion is sometimes isolated but most often secondary to other pathologies, such as femoroacetabular impingement or hip instability. This lesion is often the cause of pain. During an arthroscopy, the main objective is to save the labrum by performing a suture: Harpoons inserted into the bone (anchors) allow it to be reattached to the rim of the acetabulum. Parts of the labrum that are too frayed and not amenable to suturing are debrided, trying to preserve as much labral tissue as possible. 3) Cartilage lesions Like labral lesions, they are most often secondary to femoroacetabular impingement or hip instability. When these lesions are in their early stages, they can benefit from treatment under arthroscopy. The possible technical procedures vary according to the indications: bone microfracture, cartilage grafting, mosaicplasty, etc. 4) Synovial pathologies The synovial membrane lines the inner surface of all joints. It produces a lubricating fluid called synovial fluid and plays a significant biochemical and immunological role. Certain synovial pathologies can lead to the destruction of the hip cartilage. The most common are synovial chondromatosis (formation of cartilage “flakes” in the joint cavity) and pigmented villonodular synovitis (thickening of the synovial membrane in the form of villi and nodules). These are benign tumor pathologies in both cases, but the accompanying inflammation can be very painful and resistant to non-surgical treatment, hence the need for intervention. Arthroscopy allows for visual diagnostic confirmation and intra-articular biopsies, as well as treatment by debridement (partial or complete depending on the pathology) of the synovial membrane. It also allows for the removal of cartilage “flakes” from the joint cavity. 5) Hip tendinitis and tendinopathy It’s the inflammation of one or more tendons around the hip that causes your pain and discomfort. It can be a simple inflammation, or more significant lesions such as a tear or rupture of the tendon. This is then referred to as tendinopathy. Most often, it involves the tendons of the gluteus medius, gluteus minimus, or iliopsoas. As with the rotator cuff in the shoulder, debridement with repair of the damaged tendon can be performed either openly or by arthroscopy, depending on the type, extent, and location of the lesion. Anchors can be used if necessary to reattach the tendon to its bony insertion. 6) Hip microinstability It involves excessive laxity of your joint, or a shallow acetabulum, leading to insufficient coverage of the femoral head, which can result in lesions of the labrum and/or cartilage. The treatment addresses the articular capsule, which contains the ligaments stabilizing the hip and can be tightened. This procedure is known as capsular plication. In severe cases where there is a significant coverage defect of the femoral head in a very young patient, a hip impingement surgery can be performed. This involves grafting a small bone block onto the roof of the acetabulum to increase its coverage. Is there an alternative to surgery? In most cases, the medical treatment of hip pain is a mandatory step. We have a multitude of “small means” to try to control the symptoms without surgery: Avoiding traumatic movements or extreme positions, injections, PRP injections, anti-inflammatories, and painkillers, etc. Well-conducted physical therapy can be of decisive utility: through specific work to correct certain movements, and by primarily strengthening the muscle groups that separate the bones in conflict, it can improve symptoms and avoid surgery. If the well-followed medical treatment proves insufficient and the impact of symptoms on your physical and sports activities is significant, performing a hip arthroscopy becomes necessary. Your surgery: In the month preceding the surgery, you will have a consultation with the anesthetist, who will analyze all your medical data and will propose the type of anesthesia accordingly: general anesthesia (you are completely asleep throughout the surgery) or

L’article HIP ARTHROSCOPY est apparu en premier sur Dr Majed Issa.

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Hip arthroscopy is a recent technique, developing rapidly over the past fifteen years, allowing for the repair of the joint when it is not yet too damaged. Thus, it is part of the treatments that preserve the native hip.

Indeed, we are increasingly realizing that at least 40% of hip osteoarthritis could be due to untreated old lesions or small anatomical defects leading to the slow and progressive destruction of the joint.

Hip-preserving surgery, notably arthroscopy, allows for the repair of these lesions and anatomical defects in patients before the joint damage becomes irreversible and hip replacement becomes the only remaining solution.

Arthroscopy involves the insertion of a camera and thin instruments into the joint to perform a surgical intervention without tissue destruction. There is no muscle cutting, and the scars are pinpoint.

This process, therefore, allows for a quicker recovery, which is why arthroscopies are most often performed on an outpatient basis.

What pathologies can be treated with hip arthroscopy?

1) Femoroacetabular Impingement (FAI):

This is a dynamic pathology, characterized by the abnormal contact of the femoral neck against the rim of the acetabulum during hip flexion and rotation. The labrum and the cartilage on this rim are repeatedly crushed, leading to their fissuring.

This contact can originate either from the presence of a bone bump on the femoral neck (cam effect), or from a too prominent acetabular rim (pincer or clamp effect). The combination of both deformities is common, referred to as a mixed impingement.

Certain sports requiring large ranges of motion are particularly prone to impingements, such as combat sports, classical dance, ballet, etc. Some professions are also predisposed, especially those requiring squatting on the ground (e.g., tilers, mechanics), or extreme prolonged or repetitive hip flexion (e.g., taxi drivers).

The procedure involves shaving the bone areas causing the impingement, at the level of the femur and/or the acetabulum, using a motorized arthroscopic burr. It is often also necessary to repair sequela lesions of the impingement, such as tears of the labrum or cartilage.

2) Labral lesions

The labrum is an elastic joint attached to the periphery of the acetabulum, which ensures the tightness and stability of the hip. It has the same consistency as a meniscus in the knee, somewhat like soft rubber.

Its lesion is sometimes isolated but most often secondary to other pathologies, such as femoroacetabular impingement or hip instability. This lesion is often the cause of pain.

During an arthroscopy, the main objective is to save the labrum by performing a suture: Harpoons inserted into the bone (anchors) allow it to be reattached to the rim of the acetabulum.

Parts of the labrum that are too frayed and not amenable to suturing are debrided, trying to preserve as much labral tissue as possible.

3) Cartilage lesions

Like labral lesions, they are most often secondary to femoroacetabular impingement or hip instability. When these lesions are in their early stages, they can benefit from treatment under arthroscopy.

The possible technical procedures vary according to the indications: bone microfracture, cartilage grafting, mosaicplasty, etc.

4) Synovial pathologies

The synovial membrane lines the inner surface of all joints. It produces a lubricating fluid called synovial fluid and plays a significant biochemical and immunological role.

Certain synovial pathologies can lead to the destruction of the hip cartilage.

The most common are synovial chondromatosis (formation of cartilage "flakes" in the joint cavity) and pigmented villonodular synovitis (thickening of the synovial membrane in the form of villi and nodules). These are benign tumor pathologies in both cases, but the accompanying inflammation can be very painful and resistant to non-surgical treatment, hence the need for intervention.

Arthroscopy allows for visual diagnostic confirmation and intra-articular biopsies, as well as treatment by debridement (partial or complete depending on the pathology) of the synovial membrane.

It also allows for the removal of cartilage "flakes" from the joint cavity.

5) Hip tendinitis and tendinopathy

It's the inflammation of one or more tendons around the hip that causes your pain and discomfort. It can be a simple inflammation, or more significant lesions such as a tear or rupture of the tendon. This is then referred to as tendinopathy.

Most often, it involves the tendons of the gluteus medius, gluteus minimus, or iliopsoas.

As with the rotator cuff in the shoulder, debridement with repair of the damaged tendon can be performed either openly or by arthroscopy, depending on the type, extent, and location of the lesion. Anchors can be used if necessary to reattach the tendon to its bony insertion.

6) Hip microinstability

It involves excessive laxity of your joint, or a shallow acetabulum, leading to insufficient coverage of the femoral head, which can result in lesions of the labrum and/or cartilage.

The treatment addresses the articular capsule, which contains the ligaments stabilizing the hip and can be tightened. This procedure is known as capsular plication.

In severe cases where there is a significant coverage defect of the femoral head in a very young patient, a hip impingement surgery can be performed. This involves grafting a small bone block onto the roof of the acetabulum to increase its coverage.

Is there an alternative to surgery?

In most cases, the medical treatment of hip pain is a mandatory step.

We have a multitude of “small means” to try to control the symptoms without surgery: Avoiding traumatic movements or extreme positions, injections, PRP injections, anti-inflammatories, and painkillers, etc.

Well-conducted physical therapy can be of decisive utility: through specific work to correct certain movements, and by primarily strengthening the muscle groups that separate the bones in conflict, it can improve symptoms and avoid surgery.

If the well-followed medical treatment proves insufficient and the impact of symptoms on your physical and sports activities is significant, performing a hip arthroscopy becomes necessary.

Your surgery:

In the month preceding the surgery, you will have a consultation with the anesthetist, who will analyze all your medical data and will propose the type of anesthesia accordingly: general anesthesia (you are completely asleep throughout the surgery) or spinal anesthesia (injection in the back similar to an epidural, only the lower body is anesthetized). You will be able to share your preferences. Each anesthesia method has its advantages. If you do not want to see, hear, or feel anything, general anesthesia is ideal for you.

If you are apprehensive about falling asleep and prefer to keep a sense of “control” over the situation, you can request spinal anesthesia. Hip arthroscopy cannot be performed under pure local anesthesia.

During the surgery, you are laid on your back on a special table, called an orthopedic table. It allows us to position and hold the legs and therefore the hip. Hip arthroscopy is most often performed under radiological control using a mobile radiographic arch.

In most cases, the surgery is carried out on an outpatient basis. I will come to see you in your room at the end of the day before your discharge and will give you post-operative instructions, as well as prescriptions (dressings, painkillers, physiotherapy, etc.). You will probably have to walk with crutches for a few weeks, with or without bearing weight on the operated side, depending on your case. A daily injection of anticoagulant is necessary to avoid the risk of thrombosis. In some cases, a high-dose anti-inflammatory treatment is prescribed for a short period to prevent the formation of post-operative tissue calcifications.

We will meet regularly for follow-up consultations, and we will plan together the stages of rehabilitation, as well as the gradual resumption of regular activities, especially sports, work, and driving.

The final result of the surgery can only be evaluated after 6 months and sometimes up to 1 to 2 years. Do not forget that your joint has been ill for several months, if not years. Your muscles have weakened in parallel. With regular and well-measured efforts, without going too fast or too strong, you will experience constant progress, sometimes punctuated by small setbacks that should not worry or discourage you!

Appearance of scars after hip arthroscopy

L’article HIP ARTHROSCOPY est apparu en premier sur Dr Majed Issa.

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