Latest journal articles about hip arthroplasty and reconstruction from Journal of Arthroplasty, The Bone & Joint Journal, Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, Acta Orthopaedica, Orthopedic Clinics of North, America, Journal of Orthopaedic Surgery and Research, Orthopedics
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High Frequency of Adverse Local Tissue Reactions in Asymptomatic Patients With Metal-on-Metal THA.
Clin Orthop Relat Res. 2013 Aug 22;
Authors: Fehring TK, Odum S, Sproul R, Weathersbee J
Abstract
BACKGROUND: The key to successful management of patients with metal-on-metal (MOM) THAs is to diagnose adverse local tissue reactions (ALTRs) early. ALTRs have been described in asymptomatic patients with resurfacing arthroplasties. Whether this concerning finding applies to modular MOM THAs is unknown.
QUESTIONS/PURPOSES: We (1) determined the prevalence of ALTRs in asymptomatic patients with modular MOM THAs, (2) described any differences in the appearance of these lesions between symptomatic and asymptomatic patients, and (3) analyzed potential predictive factors for any associations with ALTR prevalence.
METHODS: We evaluated 114 patients with modular MOM THAs who had MRI with metal artifact reduction sequence software and metal ion laboratory results at a mean of 57 months postoperatively. There were 83 asymptomatic and 31 symptomatic patients. We defined ALTRs as abnormal fluid collections, solid or semisolid pseudotumors, or muscle or bone damage. Ion levels, lesion size, and cup abduction angles were analyzed.
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A Randomized Trial Comparing Acetabular Component Fixation of Two Porous Ingrowth Surfaces Using RSA.
J Arthroplasty. 2013 Aug 13;
Authors: Naudie DD, Somerville L, Korczak A, Yuan X, McCalden RW, Holdsworth D, Bourne RB
Abstract
Several new porous ingrowth surfaces for acetabular component fixation have recently been developed. The purpose of this study was to compare the in vivo fixation achieved by two different porosity ingrowth surfaces using radiostereometric analysis (RSA). Sixty-two patients undergoing primary total hip arthroplasty (THA) were randomized to receive a cementless acetabular component with either a 61% high porosity asymmetric titanium porous surface (StikTite, Smith and Nephew, TN, USA) or a 45% low porosity sintered bead porous surface (Roughcoat, Smith and Nephew, TN, USA). RSA and clinical follow-up examinations were done post-operatively, 6-weeks, 3-months, 6-months, 1-year and 2-years. Both the high porosity StikTite and lower porosity Roughcoat surfaces provided excellent biologic fixation.
PMID: 23953963 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23953963?dopt=Abstract
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Surgical Technique: Gluteus Maximus and Tensor Fascia Lata Transfer for Primary Deficiency of the Abductors of the Hip.
Clin Orthop Relat Res. 2013 Aug 18;
Authors: Whiteside LA
Abstract
BACKGROUND: Avulsion of the abductor muscles of the hip may cause severe limp and pain. Limited literature is available on treatment approaches for this problem, and each has shortcomings. This study describes a muscle transfer technique to treat complete irreparable avulsion of the hip abductor muscles and tendons.
DESCRIPTION OF TECHNIQUE: Ten adult cadaver specimens were dissected to determine nerve and blood supply point of entry in the gluteus maximus and tensor fascia lata (TFL) and evaluate the feasibility and safety of transferring these muscles to substitute for the gluteus medius and minimus. In this technique, the anterior portion of the gluteus maximus and the entire TFL are mobilized and transferred to the greater trochanter such that the muscle fiber direction of the transferred muscles closely matches that of the gluteus medius and minimus.
METHODS: Five patients (five hips) were treated for primary irreparable disruption of the hip abductor muscles using this technique between January 2008 and April 2011. All patients had severe or moderate pain, severe abductor limp, and positive Trendelenburg sign. Patients were evaluated for pain and function at a mean of 28 months (range, 18-60 months) after surgery.
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Implant Standardization for Hemiarthroplasty: Implementation of a Pricing Matrix System at a Level II Community Based Trauma System.
J Arthroplasty. 2013 Aug 14;
Authors: Althausen PL, Lu M, Thomas KC, Shannon SF, Biagi BN, Boyden EM
Abstract
Our purpose was to perform a clinical and financial analysis of a pricing matrix system on operative hip fracture care concerning hemiarthroplasty for displaced femoral neck fractures in elderly low demand patients. Data analysis on 81 pre-matrix and 88 post-matrix patients demonstrated no significant differences in age, sex, ASA or fracture pattern between the two groups. No difference in surgical approach, cement use, prosthesis choice, operative time, estimated blood loss, or intra-operative complication rate was observed. No radiographic difference in subsidence or loosening was demonstrated. Readmission form cardiac, UTI, PE or DVT rates were similar between groups and no increase in revision surgery or mortality was observed. Overall, our hospital realized a 37% reduction in implant costs, resulting in $165,500 savings for the calendar year.
PMID: 23953393 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23953393?dopt=Abstract
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Patients Respond Similarly to Paper and Electronic Versions of the WOMAC and SF-12 Following Total Joint Arthroplasty.
J Arthroplasty. 2013 Aug 14;
Authors: Marsh JD, Bryant DM, Macdonald SJ, Naudie DD
Abstract
The purpose of this study was to determine agreement between responses on electronic and paper versions of the WOMAC and SF-12(v2) questionnaires following total hip and total knee arthroplasty. Patients completed both electronic and paper questionnaires with a one week interval in-between. The order in which they completed the two versions was randomly assigned. A total of 53 patients completed the study, with a mean age of 69years (range 50-90years). The intraclass correlation coefficients (ICC) were high, indicating excellent agreement (WOMAC ICC=0.96, 95% CI 0.94-0.98), SF-12 (PCS) ICC=0.95, 95% CI 0.92-0.97; SF-12 (MCS) ICC=0.92, 95%CI 0.86-0.95). Online data collection may be substituted for the traditional paper method with no significant effect on the criterion validity of the questionnaires.
PMID: 23953392 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23953392?dopt=Abstract
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What Happens to Serum Metal Ion Levels After a Metal-on-Metal Bearing is Removed?
J Arthroplasty. 2013 Aug 12;
Authors: Ball ST, Severns D, Linn M, Meyer RS, Swenson FC
Abstract
Serum cobalt (Co) and chromium (Cr) levels are commonly used to screen for excessive wear of metal-on-metal hip replacements. However, it is unknown how rapidly these should decline after revision. 25 patients with average Co and Cr ion levels of 56.3μg/L and 20.5μg/L were followed with serial ion level testing post-revision. Over the first 6weeks post-revision, the rate of decline for Co and Cr was approximately 2% per day and this slowed to approximately 1% decline per day over the ensuing 6weeks. This translated to a decline of approximately 80% from the starting value after 6weeks and a decline of approximately 90% after 12weeks post-revision. The rate of decline for both Co and Cr was significantly faster during the first 6weeks (P<0.001). In patients with ultra-high Cr levels>20μg/L, the rate of Cr decline is less predictable and may be protracted leading to persistent elevation above 5μg/L for one year or more post-revision in some cases.
PMID: 23948123 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23948123?dopt=Abstract
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