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Related Articles

Range of Motion in a Modular Femoral Stem System with a Variety of Neck Options.

J Arthroplasty. 2013 Jul 23;

Authors: Hariri S, Chun S, Cowan JB, Bragdon C, Malchau H, Rubash HE

Abstract
Modular femoral stem systems decouple leg length, offset, and version. The hip ROM and type of impingement for 162 femoral head/neck combinations were measured at four extreme hip positions in a Sawbones pelvis and femur to identify constructs that lead to early impingement. Hip ROM increased in all positions with increasing head size and neck length. We identified a new type of impingement created by the build-up of the proximal femoral stem: femoral stem on acetabular liner impingement. Seventy percent of neutral neck options achieved our definition of acceptable ROM. In general, when utilizing a modular femoral stem, surgeons can minimize impingement by choosing the longest femoral neck that does not over-lengthen the limb, using the largest femoral head accommodated by the cup, and avoiding neck version unless the cup or stem is malaligned.

PMID: 23886407 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23886407?dopt=Abstract

Related Articles

Topical Tranexamic Acid Reduces Blood Loss and Transfusion Rates in Total Hip and Total Knee Arthroplasty.

J Arthroplasty. 2013 Jul 22;

Authors: Konig G, Hamlin BR, Waters JH

Abstract
The objective of this study was to determine if tranexamic acid (TXA) applied topically reduced postoperative bleeding and transfusion rates after primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA). Two hundred and ninety consecutive patients from a single surgeon were enrolled. In TKA, TXA solution was injected into the knee after closure of the arthrotomy. In THA, the joint was bathed in TXA solution at three points during the procedure. In both THA and TKA the TXA solution was at a concentration of 3 g TXA per 100 mL saline. The mean blood loss was significantly higher in the non-TXA patients in both TKA and THA groups. Postoperative transfusions decreased dramatically with TXA, dropping from 10% to 0%, and from 15% to 1%, in the TKA and THA groups, respectively. Topical application of TXA significantly reduces postoperative blood loss and transfusion risk in TKA and THA.

PMID: 23886406 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23886406?dopt=Abstract

Related Articles

Multiple Cultures and Extended Incubation for Hip and Knee Arthroplasty Revision: Impact on Clinical Care.

J Arthroplasty. 2013 Jul 22;

Authors: Dehaan A, Huff T, Schabel K, Doung YC, Hayden J, Barnes P

Abstract
The impact on patient care of introducing a protocol of obtaining 5 or more intra-operative separate tissue biopsies that were cultured for 10days was assessed for hip and knee arthroplasty revision. The charts of seventy-three patients undergoing 77 cases of revision arthroplasty were reviewed one year post-operatively. When compared to the prior standard of obtaining only one intra-operative culture, the protocol changed the microbiological diagnosis in 26/77 cases (34%, 95% Confidence Interval (CI): 23-45%) and antibiotic treatment in 23/77 cases (30%, 95% CI: 20-41%). In addition, the protocol had a predictive value of joint sterility in culture negative cases of 95% (95% CI: 85-99%). This data demonstrated the new protocol significantly changed patient care, and suggests that 1 or 2 cultures are insufficient. Adopting a similar protocol should be considered by surgeons and institutions as a new minimum standard for management of prosthetic joint infections.

PMID: 23886405 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23886405?dopt=Abstract

Related Articles

CORR Insights(®): Hip Resurfacing Does Not Improve Proprioception Compared With THA.

Clin Orthop Relat Res. 2013 Jul 25;

Authors: Pitto RP

PMID: 23884800 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23884800?dopt=Abstract

Related Articles

Correlation of Aspiration Results With Periprosthetic Sepsis in Revision Total Hip Arthroplasty.

J Arthroplasty. 2013 Jul 18;

Authors: Chalmers PN, Sporer SM, Levine BR

Abstract
A retrospective chart review was performed of all patients who had undergone revision total hip arthroplasty with a synovial aspiration with greater than 100 WBC since the institution of our electronic medical record. Infection was defined using a combination of criteria. A diagnosis of periprosthetic sepsis was established in 52 of the 253 included hips. No significant differences existed with respect to gender, age, BMI, Deyo-Charlson Comorbidity Index, or the cause of initial hip degeneration. Using receiver-operating characteristic curves accuracy was maximized for WBC of 745 or segmented cell count of 73.5% with a sensitivity of 98%, specificity of 37%, negative predictive value of 99% and accuracy of 50%. Application of the current American Academy of Orthopaedic Surgery Clinical Practice Guidelines (AAOS CPG) thresholds revealed a similar accuracy of 49%.

PMID: 23871708 [PubMed - as supplied by publisher]

Read more... http://www.ncbi.nlm.nih.gov/pubmed/23871708?dopt=Abstract