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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Durable Fixation Achieved With Medialized, High Hip Center Cementless THAs for Crowe II and III Dysplasia.
Clin Orthop Relat Res. 2013 Jul 25;
Authors: Nawabi DH, Meftah M, Nam D, Ranawat AS, Ranawat CS
Abstract
BACKGROUND: A high hip center total hip arthroplasty (THA) for dysplasia allows more complete socket coverage by native bone at the expense of abnormal hip biomechanics. Despite poor results with cemented components, intermediate-term results with cementless cups at a high hip center have been promising, but there are few reports at long-term followup without bone graft.
QUESTIONS/PURPOSES: The purpose of this study was to examine (1) survivorship; 2) radiographic results; and 3) hip scores at a minimum of 10 years for patients treated with high hip center cementless THA for Crowe II and III dysplasia without bone graft.
METHODS: We reviewed charts and radiographs of 32 patients with Crowe II or III dysplasia who were treated with high hip center cementless THA; at a mean followup of 12 years (range, 10-21 years), 23 patients (27 hips) were available for review. We sought to medialize cups to the inner table to achieve bony coverage of > 75%. At final followup, the WOMAC and Harris hip scores were recorded. Radiographic analysis including computerized wear evaluation was performed. Radiographic parameters were compared with a control group of 23 patients with Crowe I dysplasia who had cementless cups placed at an
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Extramedullary Guides Versus Portable, Accelerometer-Based Navigation for Tibial Alignment in Total Knee Arthroplasty: A Randomized, Controlled Trial.
J Arthroplasty. 2013 Jul 18;
Authors: Nam D, Cody EA, Nguyen JT, Figgie MP, Mayman DJ
Abstract
Extramedullary (EM) tibial alignment guides have demonstrated a limited degree of accuracy in total knee arthroplasty (TKA). The purpose of this study was to compare the tibial component alignment obtained using a portable, accelerometer-based navigation device versus EM alignment guides. One hundred patients were enrolled in this prospective, randomized controlled study to receive a TKA using either the navigation device, or an EM guide. Standing AP hip-to-ankle and lateral knee-to-ankle radiographs were obtained at the first, postoperative visit. 95.7% of tibial components in the navigation cohort were within 2° of perpendicular to the tibial mechanical axis, versus 68.1% in the EM cohort (P<0.001). 95.0% of tibial components in the navigation cohort were within 2° of a 3° posterior slope, versus 72.1% in the EM cohort (P=0.007). A portable, accelerometer-based navigation device decreases outliers in tibial component alignment compared to conventional, EM alignment guides in TKA.
PMID: 23871707 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23871707?dopt=Abstract
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Do Jumbo Cups Cause Hip Center Elevation in Revision THA? A Computer Simulation.
Clin Orthop Relat Res. 2013 Jul 25;
Authors: Nwankwo C, Dong NN, Heffernan CD, Ries MD
Abstract
BACKGROUND: Acetabular revision THA with use of a large (jumbo) cup is an effective treatment for many cavitary and segmental peripheral bone defects. However, the jumbo cup may result in elevation of the hip center and protrusion through the anterior acetabular wall as a result of the oversized geometry of the jumbo cup compared with the physiologic acetabulum.
QUESTIONS/PURPOSES: The purpose of this computer simulation was to determine how much elevation of the hip center and anterior wall protrusion occurs in revision THA with use of a jumbo cup technique in which the inferior edge of the jumbo cup is placed at the inferior acetabular rim and the superior edge of the jumbo cup is placed against host bone at the superior margin of a posterosuperior bone defect.
METHODS: Two hundred sixty-five pelvic CT scans were analyzed by custom CT analytical software. The computer simulated oversized reaming. The vertical and anterior reamer center shifts were measured, and anterior column bone removal was determined.
RESULTS: The computer simulation demonstrated that the hip center shifted 0.27 mm superiorly and 0.02 mm anteriorly, and anterior column bone removal increased 0.86 mm for every 1-mm increase in reamer diameter.
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Treatment of Pseudotumors After Metal-on-Metal Hip Resurfacing Based on Magnetic Resonance Imaging, Metal Ion Levels and Symptoms.
J Arthroplasty. 2013 Jul 18;
Authors: van der Weegen W, Sijbesma T, Hoekstra HJ, Brakel K, Pilot P, Nelissen RG
Abstract
Peri-prosthetic pseudotumor formation can be a severe complication following Metal-on-Metal hip resurfacing arthroplasty (MoMHRA), with limited data on the optimal management of this complication. The aims of this study were (1) to evaluate the prevalence and severity of pseudotumors in a consecutive cohort of 248 MoMHRA (214 patients, mean follow-up 4.6years, range: 1 - 8.2), and (2) to present a clinical guideline for their treatment based on severity grading with Metal Artefact Reduction Sequence Magnetic Resonance Imaging, metal ion levels and symptoms. Pseudotumor prevalence was 36.3%: 61 mild, 25 moderate and four were graded severe. Five revisions followed, all in symptomatic patients with elevated metal ion levels. Pseudotumor severity grading allowed us to be conservative with revision surgery for mild and moderate MoM disease.
PMID: 23871706 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23871706?dopt=Abstract
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The 2013 Frank Stinchfield Award: Diagnosis of Infection in the Early Postoperative Period After Total Hip Arthroplasty.
Clin Orthop Relat Res. 2013 Jul 25;
Authors: Yi PH, Cross MB, Moric M, Sporer SM, Berger RA, Della Valle CJ
Abstract
BACKGROUND: Diagnosis of periprosthetic joint infection (PJI) can be difficult in the early postoperative period after total hip arthroplasty (THA) because normal cues from the physical examination often are unreliable, and serological markers commonly used for diagnosis are elevated from the recent surgery.
QUESTIONS/PURPOSES: The purposes of this study were to determine the optimal cutoff values for erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial fluid white blood cell (WBC) count, and differential for diagnosing PJI in the early postoperative period after primary THA.
METHODS: We reviewed 6033 consecutive primary THAs and identified 73 patients (1.2%) who underwent reoperation for any reason within the first 6 weeks postoperatively. Thirty-six of these patients were infected according to modified Musculoskeletal Infection Society criteria. Mean values for the diagnostic tests were compared between groups and receiver operating characteristic curves generated along with an area under the curve (AUC) to determine test performance and optimal cutoff values to diagnose infection.
RESULTS: The best test for the diagnosis of PJI was the synovial fluid WBC count
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CORR Insights(®): Outcome of One-stage Cementless Exchange for Acute Postoperative Periprosthetic Hip Infection.
Clin Orthop Relat Res. 2013 Jul 19;
Authors: Manner P
PMID: 23868424 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23868424?dopt=Abstract
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