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What Causes Unexplained Pain in Patients With Metal-on metal Hip Devices? A Retrieval, Histologic, and Imaging Analysis.

Clin Orthop Relat Res. 2013 Jul 30;

Authors: Nawabi DH, Nassif NA, Do HT, Stoner K, Elpers M, Su EP, Wright T, Potter HG, Padgett DE

Abstract
BACKGROUND: Adverse tissue reactions associated with metal-on-metal (MOM) hips are common in resurfacing and total hip arthroplasty (THA) designs. The etiology of these reactions in painful, well-positioned arthroplasties is inconsistently described.
QUESTIONS/PURPOSES: The purposes of this study were to compare the (1) articular wear rates; (2) histologic findings; (3) synovial response on MRI; and (4) graded intraoperative tissue damage between well-positioned, MOM hips revised for unexplained pain and MOM hips revised for other reasons and to (5) determine whether the presence of a taper junction on a MOM articulation affects these four parameters in unexplained pain.
METHODS: We retrospectively studied 88 patients (94 hips) who had undergone revision of either a hip resurfacing or a large-head (> 36 mm) THA. Thirty-five hips revised for unexplained pain were compared with a control group of 59 hips revised for other causes. Articular wear was measured using three-dimensional contactless metrology and histologic analysis was performed using the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) score. Preoperative MRI was performed on 57 patients to

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Do Larger Femoral Heads Improve the Functional Outcome in Total Hip Arthroplasty?

J Arthroplasty. 2013 Jul 25;

Authors: Allen CL, Hooper GJ, Frampton CM

Abstract
Use of larger diameter femoral heads has been popularised in total hip arthroplasty (THA). Recent studies have implicated larger femoral heads in early failure. We evaluated what effect the size of the femoral head had on the early functional outcome in order to determine the optimal head size for the maximal functional outcome. There were 726 patients who underwent elective THA and were divided into 3 groups according to head size then compared with respect to functional outcome scores and dislocation rates. This study failed to show that increasing the size of the femoral head significantly improved the functional outcome at 1year after total hip arthroplasty but that the use of a 36mm or greater femoral head did reduce the dislocation rate.

PMID: 23891058 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23891058?dopt=Abstract

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Incorporating Patient-reported Outcomes in Total Joint Arthroplasty Registries: Challenges and Opportunities.

Clin Orthop Relat Res. 2013 Jul 30;

Authors: Franklin PD, Harrold L, Ayers DC

Abstract
BACKGROUND: Total joint arthroplasty (TJA) registries traditionally have focused on implant longevity and rates of revision surgery. Registries would benefit from the addition of standardized patient-reported outcomes (PROs) such as pain relief and improved physical function. However, PROs have not been routinely adopted, and their incorporation into TJA registries presents challenges.
QUESTIONS/PURPOSES: We review current PRO use by existing national registries, challenges to integrating PROs in national registries, lessons from national registries that have integrated PROs, and suggestions to guide future adoption of PROs.

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Incidence of and Risk Factors for 30-Day Readmission Following Elective Primary Total Joint Arthroplasty: Analysis From the ACS-NSQIP.

J Arthroplasty. 2013 Jul 25;

Authors: Pugely AJ, Callaghan JJ, Martin CT, Cram P, Gao Y

Abstract
Recently, the government has moved towards public reporting of 30-day readmission rates after elective primary total knee (TKA) and total hip arthroplasty (THA). We identified 11,814 and 8105 patients who underwent primary TKA and THA from the 2011 ACS NSQIP. Overall readmission rates within 30-days of surgery were 4.6% for TKA and 4.2% for THA. Complications associated with readmission were predominantly wound infections, sepsis, thromboembolic, cardiac, and respiratory related. In TKA, multivariate analysis identified age (P=0.002), male gender (P=0.03), cancer history (P=0.008), elevated BUN (P=0.002), a bleeding disorder (P<0.001) and high ASA class (P<0.001) as predictors of readmission. In THA, obesity (P=0.008), steroid use (P=0.037), a bleeding disorder (P=0.002), dependent functional status (P=0.022), and high ASA class (P<0.001) predicted readmission. Understanding characteristics associated with readmission will be essential for equitable patient risk stratification.

PMID: 23891054 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23891054?dopt=Abstract

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Transfusion Rates Are Increasing Following Total Hip Arthroplasty: Risk Factors and Outcomes.

J Arthroplasty. 2013 Jul 26;

Authors: Browne JA, Adib F, Brown TE, Novicoff WM

Abstract