The Journal of Arthroplasty via MedWorm.com

Conflict of Interest

The Journal of Arthroplasty — Sat, 14 Jan 2012 14:40:25 +0100

(Source: The Journal of Arthroplasty)

Instructions to Authors

The Journal of Arthroplasty — Sat, 14 Jan 2012 14:40:25 +0100

(Source: The Journal of Arthroplasty)

The Journal of Arthroplasty — Sat, 14 Jan 2012 14:40:24 +0100

(Source: The Journal of Arthroplasty)

Masthead

The Journal of Arthroplasty — Sat, 14 Jan 2012 14:40:24 +0100

(Source: The Journal of Arthroplasty)

Editorial Board

The Journal of Arthroplasty — Sat, 14 Jan 2012 14:40:23 +0100

(Source: The Journal of Arthroplasty)

The 21st Annual Meeting of the American Association of Hip and Knee Surgeons, November 4-6, 2011, Dallas, TX

The Journal of Arthroplasty — Sat, 14 Jan 2012 14:40:23 +0100

(Source: The Journal of Arthroplasty)

To Our Dear Friend, Dick Rothman

The Journal of Arthroplasty — Sat, 14 Jan 2012 14:40:07 +0100

We are all biased in some way. Each of us has to confess to a major degree of bias as we crafted this editorial - we love The Journal of Arthroplasty (JOA) and we love our friend Dick Rothman. But this cannot detract from the incredible accomplishments of Richard Rothman, MD., PhD, in his 19 years as the Editor-in-Chief of the JOA. (Source: The Journal of Arthroplasty)

Conflict of Interest Statement

The Journal of Arthroplasty — Tue, 13 Dec 2011 17:33:28 +0100

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Instructions to Authors

The Journal of Arthroplasty — Tue, 13 Dec 2011 17:33:28 +0100

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The Journal of Arthroplasty — Tue, 13 Dec 2011 17:33:28 +0100

(Source: The Journal of Arthroplasty)

Masthead

The Journal of Arthroplasty — Tue, 13 Dec 2011 17:33:28 +0100

(Source: The Journal of Arthroplasty)

Editorial Board

The Journal of Arthroplasty — Tue, 13 Dec 2011 17:33:28 +0100

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A Novel Technique for Femoral Canal Occlusion During Cement Pressurization in Proximal Femoral Arthroplasty

The Journal of Arthroplasty — Tue, 13 Dec 2011 17:33:28 +0100

We describe a novel technique for occluding the femoral canal distal to the isthmus during proximal femoral arthroplasty. Synthetic bone models were reamed and sectioned to simulate loss of the proximal femur. Two experimental conditions were used. The first used no restrictor to act as a control. The second used calcium sulphate pellets impacted in distal femoral canal. A 100 × 12 mm Limb Preservation System stem (DePuy, Leeds, UK) was used in all experiments. We recorded cement pressure, leakage of cement, and penetration of cement into the femoral condyles. The calcium sulphate pellets prevented cement leakage, enabled higher cementing pressures, and prevented penetration of the cement into the femoral condyles. We would recommend this technique in cases where loss of proximal femoral ...

Treatment of Displaced Neck Fractures of the Femur With Total Hip Arthroplasty

The Journal of Arthroplasty — Mon, 05 Dec 2011 05:00:00 +0100

We report our experience in unstable fractures of the femoral neck in a consecutive series of patients who underwent total hip arthroplasty. Over a period of 12 years, 88 patients were treated with a cemented total hip arthroplasty; 3 patients were lost to follow-up, leaving 86 fractures (85 patients) for retrospective analysis. Seven patients had dislocations, all but 1 of which were treated successfully without reoperation. Four patients required reoperation in the same hip undergoing arthroplasty. There was a graded increase in mortality rates across the continuum of risk groups at the time of surgery. The low incidence (4.6%) of a second procedure on the hip repaired initially, as well as low mortality rates, makes this treatment strategy quite satisfactory. (Source: The Journal of Art...

Conflict of Interest

The Journal of Arthroplasty — Thu, 10 Nov 2011 17:55:56 +0100

(Source: The Journal of Arthroplasty)

Instructions to Authors

The Journal of Arthroplasty — Thu, 10 Nov 2011 17:55:56 +0100

(Source: The Journal of Arthroplasty)

The Journal of Arthroplasty — Thu, 10 Nov 2011 17:55:56 +0100

(Source: The Journal of Arthroplasty)

Masthead

The Journal of Arthroplasty — Thu, 10 Nov 2011 17:55:56 +0100

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Editorial Board

The Journal of Arthroplasty — Thu, 10 Nov 2011 17:55:56 +0100

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Does a High-Flexion Design Affect Early Outcome of Medial Unicondylar Knee Arthroplasty? Clinical Comparison at 2 Years

The Journal of Arthroplasty — Thu, 10 Nov 2011 17:55:55 +0100

Abstract: Recently, implant companies have sought to target a more active segment of the population with high-flex implants. Our aim was to compare a successful medial UKA implant with its newer high-flex version. Sixty-one patients (nonflex, 33; high-flex [HF], 28) were prospectively followed after medial UKA with a minimum of 2-year follow-up. Patients were evaluated using Short Form 12, Western Ontario and McMaster Osteoarthritis (WOMAC), Knee Society Scores, and range of motion (ROM). The HF group exhibited significantly higher WOMAC Physical Function scores at 3-month follow-up and higher WOMAC Pain and SF-12 Mental Component scores at 2-year follow-up; all other comparisons were not statistically different, including ROM. The HF cohort had significantly higher improvements in Knee So...

New Definition for Periprosthetic Joint Infection

The Journal of Arthroplasty — Thu, 10 Nov 2011 17:55:54 +0100

Abstract: Diagnosis of periprosthetic joint infection (PJI) remains a real challenge to the orthopedic community. Currently, there is no single standard definition for PJI. This communication presents the diagnostic criteria that have been proposed by a workgroup convened by the Musculoskeletal Infection Society. The diagnostic criteria were developed after the evaluation of available evidence. The role of every diagnostic test was examined, and the literature was reviewed in detail to determine the threshold for each test. It is hoped that the proposed definition for PJI will be adopted universally, bringing standardization into a field that has suffered extensive variability and heterogeneity. (Source: The Journal of Arthroplasty)

Effect of Pelvic Obliquity on the Orientation of the Acetabular Component in Total Hip Arthroplasty

The Journal of Arthroplasty — Mon, 07 Nov 2011 05:00:00 +0100

Abstract: In infrapelvic obliquity, coronal pelvic malrotation entails a change in the spatial location of the bony acetabulum. In the present study, 77 patients presented with infrapelvic obliquity with types 1 and 2 hip pathologies in which the pelvis is lower and higher, respectively, on the short-leg side. The 2 types were classified into 3 subtypes (A, B, and C) according to the severity of the pelvic obliquity (0°-3°, 3°-6°, and >6°). Angles of inclination of pelvic obliquity postoperatively, anteversions, and inclinations (abduction angle) for acetabular components were measured after total hip arthroplasty. Increased inclination (mean, 8.79°) was observed in type 1C, where the angle of inclination to pelvic obliquity postoperatively was minimally corrected. This increase may ...

In Reply:

The Journal of Arthroplasty — Mon, 24 Oct 2011 04:00:00 +0100

We appreciate Dr Hamid Namazi's insightful ideas regarding the major route that simvastatin could promote osseointegration. Certainly, his ideas have merit, and we would welcome publication of a more complete discussion of the mechanisms for simvastatin-induced osseointegration in total hip arthroplasty. (Source: The Journal of Arthroplasty)

Effects of Simvastatin on Osseointegration in a Canine Total Hip Arthroplasty Model: An Experimental Study: A Novel Molecular Mechanism

The Journal of Arthroplasty — Mon, 24 Oct 2011 04:00:00 +0100

I read with great interest the article by Yin and colleagues .This work showed that simvastatin can promote osseointegration in total hip arthroplasty. I would like to complete the discussion of Yin and colleagues by introducing a major route with which simvastatin could promote osseointegration. (Source: The Journal of Arthroplasty)

In Reply:

The Journal of Arthroplasty — Mon, 24 Oct 2011 04:00:00 +0100

This study limitation is clearly stated in the discussion section of the article. For this reason, further sub-analysis such as the influence of the acetabular cup inclination on the cup type or the rate of pseudotumours was not performed. Similarly, the lack of significant difference in the type of implant, femoral component size, or acetabular component inclination found in the pseudotumour group with the elevated serum metal ion levels may also be due to small sample size. Thirdly, as we have previously reported a detailed study on risk factors for pseudotumours based on a significantly larger sample size , the scope of this study was focused on determining prevalence in subclinical pseudotumours detected on a scan. (Source: The Journal of Arthroplasty)

The Use of a Revision Femoral Stem to Manage a Distal Femoral Periprosthetic Fracture in a Well-Fixed Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 24 Oct 2011 04:00:00 +0100

We present technique using the revision system femoral stem for the PFC Sigma TKA (Depuy; Leeds, England) to stabilize this particular type of fracture. (Source: The Journal of Arthroplasty)

To the Editor:

The Journal of Arthroplasty — Mon, 17 Oct 2011 04:00:00 +0100

This article addressed the potential asymptomatic abnormal periprosthetic soft tissue reactions (called “pseudotumors”) observed after metal-on-metal hip resurfacing arthroplasty. (Source: The Journal of Arthroplasty)

New Definition for Periprosthetic Joint Infection

The Journal of Arthroplasty — Mon, 17 Oct 2011 04:00:00 +0100

I can recall many occasions when I have been caught by surprise in evaluation of a patient with painful joint arthroplasty. Many occasions when pain attributed to a cause other than infection was found to be due to infection indeed. The latter scenario is unfortunately not infrequent. The recent guidelines developed by the workgroup convened by the American Academy of Orthopaedic Surgeons for diagnosis of periprosthetic joint infection (PJI) stresses the importance of performing screening tests (serum erythrocyte sedimentation rate and C-reactive protein) on every patient presenting with a painful prosthetic joint. It highlights the fact that PJI often presents with subtle sign and symptoms and may be easy to miss. I have noted how implementation of the American Academy of Orthopaedic Surg...

Thin Hard Crest on the Edge of Ceramic Acetabular Liners Accelerates Wear in Edge Loading

The Journal of Arthroplasty — Wed, 05 Oct 2011 04:00:00 +0100

Abstract: Ceramic acetabular liners may exhibit a small, sharp crest—an artifact of discontinuous machining steps—at the junction between the concave spherical surface and the interior edge. On 3 ceramic liners, this crest was found to form a 9° to 11° deviation from tangency. Edge loading wear tests were conducted directly on this crest and on a smoother region of the edge. The crest elicited 2 to 15 times greater volumetric wear on the femoral head. The propensity of the crest to rapidly ( (Source: The Journal of Arthroplasty)

Conflict of Interest

The Journal of Arthroplasty — Thu, 29 Sep 2011 17:30:18 +0100

(Source: The Journal of Arthroplasty)

Instructions to Authors

The Journal of Arthroplasty — Thu, 29 Sep 2011 17:30:18 +0100

(Source: The Journal of Arthroplasty)

The Journal of Arthroplasty — Thu, 29 Sep 2011 17:30:18 +0100

(Source: The Journal of Arthroplasty)

Masthead

The Journal of Arthroplasty — Thu, 29 Sep 2011 17:30:18 +0100

(Source: The Journal of Arthroplasty)

Editorial Board

The Journal of Arthroplasty — Thu, 29 Sep 2011 17:30:18 +0100

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Are Acetabular Component Alignment Guides for Total Hip Arthroplasty Accurate?

The Journal of Arthroplasty — Thu, 29 Sep 2011 04:00:00 +0100

We appreciate the comments by Drs Ng and McShane regarding our recent article, “Are Acetabular Component Alignment Guides for Total Hip Arthroplasty Accurate?” They commented on a very important issue. The problem being that most alignment guides did not use radiographic definition, but operative definition. The so-called safe zone of acetabular component orientation is expressed in “radiographic” definition. Even if the booklet indicated that “this alignment guide is based on operative definition,” most of the surgeons would be confused in the operating room. Thus, the alignment guide should be designed on the basis of radiographic definition. (Source: The Journal of Arthroplasty)

Letter to the Editor

The Journal of Arthroplasty — Thu, 29 Sep 2011 04:00:00 +0100

We would like to thank Dr Minoda and his coauthors for their recent article, “Are acetabular component alignment guides for total hip arthroplasty accurate? ” Proper cup orientation during total hip arthroplasty is indeed not only a difficult concept to understand but also a challenging task to achieve. Their article is of value because it sheds light on the potential inaccuracy of using mechanical alignment guides. However, we feel that the authors' conclusions that “the angles actually indicated and those stated by manufacturers were different” and that “the alignment guide itself could be one of the reasons for error” can further confuse readers. (Source: The Journal of Arthroplasty)

The Value of Patient-Matched Instrumentation in Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 12 Sep 2011 04:00:00 +0100

Abstract: The purpose of the current prospective, randomized study was to compare the value of a new mechanically aligned patient-matched instrument system for total knee arthroplasty (TKA) (Visionaire; Smith & Nephew, Inc, Memphis, Tenn) (VIS) to that of standard TKA surgical instrumentation (STD). Twenty-nine primary TKA patients were enrolled and completed surgery (15 VIS and 14 STD). Postoperatively, mechanical alignment was significantly closer to neutral zero in the VIS group (1.7° vs 2.8°; P = .03). Furthermore, the VIS group demonstrated significant reductions in duration of hospital stay, operative time, incision length, and number of used instrument trays (P < .05). Although additional research is underway to confirm these preliminary results, this evidence suggests that patien...

Wear of Polyethylene Against Oxidized Zirconium Femoral Components: Effect of Aggressive Kinematic Conditions and Malalignment in Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 12 Sep 2011 04:00:00 +0100

Abstract: Metallic femoral components with ceramic articulating surfaces can substantially lower polyethylene (PE) wear during walking activities under conditions of normal knee alignment. It is unknown whether these types of components can maintain low wear rates under conditions of knee malalignment and the harsher kinematics associated with younger, athletically active patients. Wear was measured in non–cross-linked, ethylene oxide–sterilized PE inserts against oxidized zirconium or cobalt-chrome femoral components in a knee wear simulator. The vertical load was modified to replicate knee varus malalignment of 3°, and the range of tibial rotation was increased to 20°. Mean gravimetric and volumetric wear rate over 5 million cycles was 55% lower in the oxidized zirconium group. An ...

Prospective Results of Uncemented Tantalum Monoblock Tibia in Total Knee Arthroplasty: Minimum 5-Year Follow-up in Patients Younger Than 55 Years

The Journal of Arthroplasty — Mon, 29 Aug 2011 04:00:00 +0100

Abstract: A significant increase in younger patients undergoing total knee arthroplasty raises the theoretical concern for revision secondary to micromotion and fixation failure with cemented components. We prospectively studied 100 consecutive tantalum monoblock uncemented tibial components and 312 concurrent cemented controls. Patients younger than 55 years with adequate bone stock were enrolled. This cementless patient group was younger and had higher preoperative functional status. Prostheses were posterior-substituting uncemented femoral and tibial components with a cemented patellar button. Knee Society pain and function scores and radiographs were obtained, and a cost analysis was performed. Knee Society scores were excellent and equivalent beyond 6 months. There was no significant ...

Conflict of Interest

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:50 +0100

(Source: The Journal of Arthroplasty)

Instructions to Authors

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:50 +0100

(Source: The Journal of Arthroplasty)

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:50 +0100

(Source: The Journal of Arthroplasty)

Masthead

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:50 +0100

(Source: The Journal of Arthroplasty)

Editorial Board

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:50 +0100

(Source: The Journal of Arthroplasty)

In Reply

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:47 +0100

: I would like to thank Drs Maheshwari and Rasquinha for their insightful questions regarding our article on the common errors in the execution of preoperative templating for primary total hip arthroplasty. We apologize for the unclear explanation we may have given in our article. The most common error identified in our templating that led to undesired lengthening is the intraoperative placement of the acetabular component inferior relative to its templated position. This would largely go unrecognized intraoperatively, and the femoral component would then be placed as per templating (predetermined neck cut). This inferior placement of the acetabular component without compensation on the femoral side led most frequently to excessive leg lengthening. This finding has resulted in a slight ch...

In Reply:

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:43 +0100

Mootha and Annaparareddy raise 4 thoughtful questions in their letter: (1) Did patients prefer the knee replaced first over the knee replaced second in our series of 880 staged bilateral knee procedures performed using different knee prosthesis on each side? (2) Did patients have comparable preoperative Knee Society Scores? (3) Do patients' preferences in knee prostheses persist over time? and (4) Is an anatomic-bicruciate or one of the functional designs (posterior stabilized, posterior cruciate, medial pivot, or mobile bearing) the preferred choice for a total knee prosthesis? (Source: The Journal of Arthroplasty)

Computer-Assisted Navigation of Total Knee Arthroplasty for Osteoarthritis in a Patient with Severe Posttraumatic Femoral Deformity

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:24 +0100

In this report, a 70-year-old woman who had a severe distal femoral deformity from a previous open fracture underwent computer-assisted TKA for osteoarthritis. The use of a computer-assisted navigation system achieved a high degree of accuracy relative to the desired target alignment and led to improved function in a patient in which standard instrumentation was not feasible. (Source: The Journal of Arthroplasty)

Protection of Repaired Patellar Tendons: A Surgical Technique

The Journal of Arthroplasty — Wed, 24 Aug 2011 19:59:17 +0100

This study describes the use of a dynamic and flexible leash to limit excursion of the patella while protecting the fragile repair. (Source: The Journal of Arthroplasty)

Early Biological Fixation of Porous Implant Coated With Paste-Retaining Recombinant Bone Morphogenetic Protein 2

The Journal of Arthroplasty — Mon, 22 Aug 2011 04:00:00 +0100

Abstract: The aim of this study was to evaluate the period required for stable initial bone-implant fixation with recombinant human bone morphogenetic protein 2 (rhBMP-2) in the bone marrow of a rabbit model. The porous implants being coated with β-tricalcium phosphate/polylactide-polyethylene glycol paste with 15, 30, or 60 μg of rhBMP-2 (n = 10) were implanted into animals in 3 experimental groups. In 2 control groups, the test implants were coated without rhBMP or no paste. In all groups, the implant was inserted for 3 and 6 weeks. At 3 weeks after implantation, the BMP-treated implants in the 2 lower dose groups had significantly more bone ingrowth to the implant surface than did the control groups, and the greatest effect occurred in the 30-μg rhBMP-2 group animals. (Source: The Jo...

Patterns of Osseointegration and Remodeling in Femoral Revision With Bone Loss Using Modular, Tapered, Fluted, Titanium Stems

The Journal of Arthroplasty — Mon, 22 Aug 2011 04:00:00 +0100

Abstract: Radiographic signs of osseointegration with the use of fluted, tapered, modular, titanium stems in revision hip arthroplasty with bone loss have not been previously categorized. Serial radiographs of 64 consecutive hips with mean follow-up of 6.2 years were retrospectively reviewed. Bone loss was classified as per Paprosky classification, osseointegration was assessed according to a modified system of Engh et al, and Harris Hip Score was used to document pain and function. Seventy-four percent of the hips had type 3 or 4 bone loss. All stems were radiographically osseointegrated. Early minor subsidence was seen in 6.2% of the hips; definite bony regeneration, 73% of the hips; and stress shielding, 26% of the hips. These osseointegration patterns were different from those describe...

The Use of Interlocking Prostheses for Both Temporary and Definitive Management of Infected Periprosthetic Femoral Fractures

The Journal of Arthroplasty — Mon, 22 Aug 2011 04:00:00 +0100

We describe our experience of managing infected periprosthetic femoral fractures using interlocking long-stem femoral prostheses either as temporary functional spacers or as definitive implants. The Cannulock (Orthodesign, Christchurch, United Kingdom) uncoated stem was used in 12 cases, and the Kent hip prosthesis (Biomet Merck, Bridgend, United Kingdom), in 5 cases. Satisfactory outcome was noted in all cases, and in 11 cases, revision to a definitive stem has been undertaken after successful control of infection and fracture union. The use of interlocking stems offers a relatively appealing solution for a complex problem and avoids the complications that would be associated with resection of the entire femur or the use of large quantities of bone cement. (Source: The Journal of Arthropl...

Ceramic-On-Ceramic Total Hip Arthroplasty in Patients Younger Than 20 Years

The Journal of Arthroplasty — Wed, 10 Aug 2011 04:00:00 +0100

This study reports the results of THA in young patients using contemporary ceramic bearings. Twenty-four THAs were performed using ceramic bearing surfaces in patients 20 years old or younger (mean, 16.4; range, 12-20). Average follow-up was 52 months (range, 25-123 months). The survival rate was 96%, with 1 revision for a loose acetabular component. Other complications included a peroneal nerve palsy that resolved and 2 dislocations in 1 patient. Postoperatively, the Modified Harris Hip Score mean was 93.4 (range, 66-100). This study shows promising results at short-term to midterm follow-up in very young patients who undergo THA using ceramic-on-ceramic components. (Source: The Journal of Arthroplasty)

Is Intra-Articular Multimodal Drug Injection Effective in Pain Management After Total Knee Arthroplasty? A Randomized, Double-Blinded, Prospective Study

The Journal of Arthroplasty — Wed, 10 Aug 2011 04:00:00 +0100

Abstract: We performed a prospective, double-blinded, randomized, and controlled study to assess the clinical efficacy and safety of intra-articular multimodal drug injection after total knee arthroplasty. Two hundred eighty-six patients undergoing simultaneous bilateral total knee arthroplasty were randomized to receive the injection of multimodal drugs in one knee and normal saline solution as a placebo in the contralateral knee. All patients received patient-controlled analgesia for 48 hours after surgery, followed by standard analgesia. Visual analog scores for pain during activity and rest and for patient satisfaction were recorded. The range of motion and blood loss were also recorded. Intraoperative intra-articular injection of multimodal drugs into the knee did not improve patient ...

Foreword

The Journal of Arthroplasty — Wed, 10 Aug 2011 04:00:00 +0100

Arthroplasty is widely recognized as the most successful surgical procedure for eliminating pain and restoring function in severely affected joints. It is more standardized now than ever before and is practiced globally including in Asia. As the most populated continent, Asia has both a rapidly aging population and an expanding economy. It is likely that Asia will soon have the highest incidence of arthroplasty procedures in the world. Therefore, it is crucial to assess the issues involved in performing arthroplasty in Asian patients and to refine its procedures in this region. (Source: The Journal of Arthroplasty)

Femoral Nerve Compression After Migration of Bone Cement to the Groin After Hip Arthroplasty

The Journal of Arthroplasty — Fri, 29 Jul 2011 04:00:00 +0100

We report the case of a 70-year-old male patient in whom an extruded cement mass migrated anteriorly and compressed the femoral nerve and impinged on the femoral artery producing acute, severe groin pain with neuralgia 9 years postoperatively. Paresthesia of the anterior and medial thigh was found on examination. Radiographic, ultrasound, and computed tomographic studies confirmed a 6 × 1.5-cm mass of bone cement in the right groin compressing the femoral nerve that was removed successfully at surgery. Six months postoperatively, the patient's pain had resolved, but hyperesthesia of the medial thigh remained. (Source: The Journal of Arthroplasty)

Total Hip Arthroplasty Surveillance: When Do We See Our Patients Postoperatively?

The Journal of Arthroplasty — Fri, 29 Jul 2011 04:00:00 +0100

Abstract: Despite the high volume of total hip arthroplasties (THAs) performed in North America, there is no consensus regarding postoperative implant surveillance. Therefore, an Internet survey of Hip Society members was performed to determine the timing of follow-up visits after THA. The surgeons were queried with respect to the time until the first and second postoperative visits and the interval of follow-up for the first and second decades. The average time until the first follow-up visit is 4.9 weeks, and 63% of patients are seen by 6 weeks after surgery. Ninety percent of respondents saw patients at 1 year after THA. Follow-up visits after year 1 were more variable. Guidelines for follow-up should be established to enhance patient outcomes over time. (Source: The Journal of Arthropl...

A Preclinical Study of Stem Subsidence and Graft Incorporation After Femoral Impaction Grafting Using Porous Hydroxyapatite as a Bone Graft Extender

The Journal of Arthroplasty — Fri, 29 Jul 2011 04:00:00 +0100

Abstract: This preclinical in vivo screening study compared bone graft incorporation and stem subsidence in cemented hemiarthroplasty after femoral impaction bone grafting with either morselized allograft bone (n = 5, control group) or a 1:1 mix of allograft and porous hydroxyapatite ceramics (HA) granules (n = 5, HA group). At 14 weeks, there was excellent bone graft incorporation by bone, and the stems were well fixed in both groups. The median subsidence at the cement-bone interface, measured using radiostereometric analysis, was 0.14 and 0.93 mm in the control and HA groups, respectively. The comparable histologic results between groups and good stem fixation in this study support the conduct of a larger scale investigation of the use of porous HA in femoral impaction bone grafting at ...

Total Hip Arthroplasty After Prior Surgical Treatment of Hip Fracture: Is it Always Challenging?

The Journal of Arthroplasty — Thu, 28 Jul 2011 04:00:00 +0100

This study compares salvage THA in patients with prior femoral neck fractures vs patients with prior intertrochanteric fractures. One hundred fifty-four hips in 152 patients underwent conversion from open reduction internal fixation to THA. Eighty-three patients had previous femoral neck fractures, and 69 patients (71 hips) had prior intertrochanteric fractures. Salvage THA in patients with prior intertrochanteric fractures presented a more technically demanding procedure with longer operative times and larger amounts of blood loss. Although conversion THA presents a technically challenging procedure, it is safe and yields relatively few orthopedic complications. (Source: The Journal of Arthroplasty)

Surgical Repair of the Gluteal Tendons: A Report of 72 Cases

The Journal of Arthroplasty — Thu, 28 Jul 2011 04:00:00 +0100

This study reports the results of investigation, the findings at surgery, the operative technique, the histopathologic findings, and the results of gluteal tendon repair in 72 patients with long-standing trochanteric pain and reports a classification of the operative findings. Six patients (7%) in the original study cohort of 89 patients were lost to follow-up, but of the remaining patients, 65 of 72, or 90%, were pain-free or had minimal pain (P < .00001). Surgical reconstruction of detached gluteal tendons causing chronic lateral hip pain addresses the problem directly and reliably relieves the symptoms of so-called “trochanteric bursitis.” (Source: The Journal of Arthroplasty)

Intramedullary Rod and Cement Static Spacer Construct in Chronically Infected Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 25 Jul 2011 04:00:00 +0100

We examined 58 infected total knee arthroplasties with extensive bone and soft tissue loss, treated with resection arthroplasty and intramedullary tibiofemoral rod and antibiotic-laden cement spacer. Thirty-seven patients underwent delayed reimplantation. Most patients (83.8%) were free from recurrent infection at mean follow-up of 29.4 months. Reinfection occurred in 16.2%, which required debridement. Twenty-one patients with poor operative risks remained with the spacer for 11.4 months. All patients, during spacer phase, had brace-free ambulation with simulated tibiofemoral fusion, without bone loss or loss of limb length. (Source: The Journal of Arthroplasty)

In Reply:

The Journal of Arthroplasty — Sun, 24 Jul 2011 23:00:00 +0100

We read, with interest, the letter of Mr Walter and welcome his comments. Certainly, his ideas have merit, and we would welcome publication of a more complete illustration of the technique he describes. We would make the following comments in reply: (Source: The Journal of Arthroplasty)

Conflict of Interest Statement

The Journal of Arthroplasty — Thu, 21 Jul 2011 17:20:18 +0100

(Source: The Journal of Arthroplasty)

Instructions to Authors

The Journal of Arthroplasty — Thu, 21 Jul 2011 17:20:18 +0100

(Source: The Journal of Arthroplasty)

The Journal of Arthroplasty — Thu, 21 Jul 2011 17:20:18 +0100

(Source: The Journal of Arthroplasty)

Masthead

The Journal of Arthroplasty — Thu, 21 Jul 2011 17:20:18 +0100

(Source: The Journal of Arthroplasty)

Editorial Board

The Journal of Arthroplasty — Thu, 21 Jul 2011 17:20:18 +0100

(Source: The Journal of Arthroplasty)

Erratum

The Journal of Arthroplasty — Thu, 21 Jul 2011 17:20:18 +0100

In the article “Fifteen-year to 19-year follow-up of the Insall-Burstein-1 total knee arthroplasty” (Abdeen et al, Journal of Arthroplasty; 25:173), an author's name is listed incorrectly in the byline. Stacy B. Collen, BSc, should have been listed as Stacy R. Collen, BSc. (Source: The Journal of Arthroplasty)

Retraction Due to Duplication: “Cement Spacer Loaded With Antibiotics for Infected Implants of the Hip Joint”The Journal of Arthroplasty, Volume 24(January 2009), Issue 1, Pages 83-95

The Journal of Arthroplasty — Thu, 21 Jul 2011 17:20:18 +0100

This article has been retracted, please see Elsevier Policy on Article Withdrawal: http://www.elsevier.com/locate/withdrawalpolicy. The editors and publisher would like to confirm the retraction of this paper at the request of the authors. This article was a duplication of a paper that had already appeared in, Journal of Orthopaedic Science (Springer Japan) Vol 8, No. 6, November, 2003 (DOI 10.1007/s00776-003-0722-y). All parties would like to apologize for this administrative error. (Source: The Journal of Arthroplasty)

Improving Initial Acetabular Component Stability in Revision Total Hip Arthroplasty: Calcium Phosphate Cement vs Reverse Reamed Cancellous Allograft

The Journal of Arthroplasty — Thu, 21 Jul 2011 04:00:00 +0100

Abstract: A reproducible retroacetabular defect was created bilaterally in 9 cadaver pelves. The defects were filled with either an injectable, bioresorbable, calcium phosphate cement, or reverse-reamed cancellous allograft. An uncemented acetabular shell was impacted, followed by the placement of an appropriate liner. The pelves were then sectioned, and each half was loaded in a material testing machine to simulate walking on the construct over a several week period. The cement-filled defects lasted a greater number of cycles before failure and had greater cup stability and stiffness. The use of resorbable bone void filler for retroacetabular defects shows promise in this biomechanical analysis. Long-term clinical follow-up is warranted to track osseointegration of the implant and restora...

All-Polyethylene Tibial Implant in Young, Active Patients: A Concise Follow-Up, 10 to 18 years

The Journal of Arthroplasty — Thu, 21 Jul 2011 04:00:00 +0100

Abstract: This is a long-term follow-up report of all-polyethylene tibial components in 60 years and younger, active patients. At the mean follow-up of 12.4 ± 2.7 (range, 10-18 years), no more patients were deceased or lost to follow-up, leaving 32 patients (44 knees) for final analysis. Good to excellent results were achieved in 96% of patients. The mean Western Ontario and McMaster Universities Osteoarthritis Index and Knee Society Score were 31 and 97, respectively. Sixty-two percent of patients were participating in sport activities such as running, gym exercises, and playing tennis or golf, with a mean UCLA score of 7.2. There were no cases of malalignment, aseptic loosening, excessive wear, or osteolysis. Seven patients (9 knees) had incomplete, nonprogressive demarcation at the zon...

Results of a Second-Generation Constrained Condylar Prosthesis in Primary Total Knee Arthroplasty

The Journal of Arthroplasty — Thu, 21 Jul 2011 04:00:00 +0100

Abstract: This is a prospective study of the results of a second-generation modular constrained condylar knee (CCK) prosthesis in primary total knee arthroplasty. Of 418 consecutive total knee arthroplasties performed by 1 surgeon, a second-generation modular CCK prosthesis was indicated for intraoperative stability in 30 knees (7.2%). Three knees were lost to follow-up, and 27 knees had a mean follow-up time of 5.4 years (range, 2-11.5 years). All tibial components had a cemented 35-mm stem extension, and 26 femoral components had a 100-mm uncemented stem extension. The indication for use of the CCK components was most commonly severe valgus deformity and incompetent medial collateral ligament. There were no revisions for loosening, patella problems, or tibial post fracture. A lateral ret...

Rehospitalizations, Early Revisions, Infections, and Hospital Resource Use in the First Year After Hip and Knee Arthroplasties

The Journal of Arthroplasty — Fri, 15 Jul 2011 04:00:00 +0100

We examined 3 negative outcomes for 58 351 hip and knee arthroplasty patients: rehospitalization, revision and infection, and their impact on resource use in the year after surgery. In the year before surgery, 12.9% of elective hip and 10.2% of knee patients were hospitalized. In the year after, 14.8% of elective hip and 15.5% of knee patients were hospitalized, representing a 15% and 52% increase, respectively. Twenty-eight percent of emergent hip patients were hospitalized at least once preoperatively; this did not change after surgery. Revision occurred in 2.0% of emergent hip, 1.7% of elective hip, and 0.9% of knee patients. Joint infection was diagnosed in 1.3% of patients. The increased hospitalization after the elective hip and knee procedures represents an incremental cost of 10% ...

Fungal Periprosthetic Hip and Knee Joint Infections: Clinical Experience With a 2-Stage Treatment Protocol

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: Fungal periprosthetic joint infections are a rare entity in orthopedic surgery, and there exist no guidelines according to which these infections can be successfully managed. Between 2004 and 2009, 7 patients with fungal periprosthetic joint infections (4 total hip arthroplasties and 3 total knee arthroplasties) have been treated with a 2-stage protocol and implantation of antibiotic-loaded cement spacers. Most of the infection was caused by Candida species. Systemic antifungal agents were administered for 6 weeks in 6 cases and 6 months in 1 case. The mean spacer implantation time was 12 weeks. At a mean follow-up of 28 months (5-70 months), no persistence of infection or reinfection could be observed. A 2-stage treatment protocol with implantation of an antibiotic-loaded cement...

Long-Term Trends in Hip Arthroplasty Use and Volume

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: We used Medicare administrative data to examine trends in primary and revision total hip arthroplasty (THA) use and hospital volume. Between 1991 and 2005, primary and revision THA use increased by 40.9% and 16.8%, respectively. The percentage of primary THA procedures performed in high-volume hospitals (those in the highest quintile of volume) increased slightly from 58.0% of all procedures in 1991 to 58.7% in 2005 (P < .01). The percentage of revisions performed in high-volume hospitals increased from 60.9% to 62.4% (P < .01). The percentage of primary THA procedures performed by low-volume hospitals remained relatively stable (P = .36), whereas the percentage of revision THA performed by low-volume hospitals declined (P < .001). In aggregate, these results suggest minimal evid...

Lateral Laxity in Flexion Increases the Postoperative Flexion Angle in Cruciate-Retaining Total Knee Arthroplasty

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: Thirty-eight patients diagnosed with osteoarthritis underwent 41 cruciate-retaining total knee arthroplasties. In varus and valgus tests at flexion, subjects were seated on a table at 80° of knee flexion; 50 N was applied perpendicular to the lower leg. The factors affecting the postoperative flexion angle were investigated in a multiregression analysis. The mean joint angles of the flexion-valgus and flexion-varus tests were 3.4° ± 1.4° and 6.2° ± 2.5°, respectively. The flexion-varus angle was correlated with the postoperative flexion angle (P < .01). The mean postoperative flexion angles were 110.8° ± 9.6° and 118.1° ± 8.0° in the groups with the flexion-varus angle of 6° or less and more than 6°, respectively (P = .02). Slack lateral laxity in flexion had a sig...

Results of Cemented Femoral Revisions for Periprosthetic Femoral Fractures in the Elderly

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: The treatment goals of Vancouver type B2 periprosthetic femoral fractures in elderly patients with a limited life expectancy are early weight bearing without compromising the fracture healing. Thirty-one patients with a mean age of 82 years were treated with a long cemented stem with additional allograft or plate fixation, followed by immediate full weight bearing. Seven major complications occurred within the first 3 months postoperatively. Forty-three percent of patients had died within the first year with their implant in place. Sixteen patients had survived more than 1 year. None of the implants had to be revised at a mean follow-up of 46 months. The results of this series suggest that this technique can provide acceptable results and offers the advantages of reduced cost and...

Greater Satisfaction in Older Patients With a Mobile-Bearing Compared With Fixed-Bearing Total Knee Arthroplasty

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: A prospective, randomized, controlled, double-blind trial was performed to compare outcomes between 61 mobile- and 58 fixed-bearing primary TKAs in patients aged 70 years or older. At last follow-up, no difference was found for Knee Society score. The mobile-bearing group had greater knee flexion at 3 and 6 months, but this was similar at 2 years. The patient satisfaction was better in the mobile-bearing group than in fixed-bearing group, with respect to Knee Society functional score, Western Ontario MacMasters University score, Short-Form 12 score, and visual analog scale score. A multivariate analysis confirmed that the only independent factors predictive of postoperative quality of life were early postoperative flexion. We believe that better perception and satisfaction with m...

To Use or Not to Use Continuous Passive Motion Post–Total Knee Arthroplasty: Presenting Functional Assessment Results in Early Recovery

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: Continuous passive motion (CPM), though of doubtful value, is yet routinely practiced post–total knee arthroplasty (TKA). We prospectively distributed 84 patients with TKA to 1 of the 3 standard rehabilitation regimes: no-CPM, 1-day-CPM, and 3-day-CPM. We recorded a unique “Timed up and go” test besides pain, Western Ontario and McMaster Universities (WOMAC), short form-12 (SF-12), range of motion, knee and calf swelling, and wound healing parameters. Our standardized and elaborate measurements preoperatively and on postoperative days 3, 5, 14, 42, and 90 showed no statistically significant difference among the 3 groups in each parameter. We concluded that CPM gives no benefit in immediate functional recovery post-TKA, and in fact, the postoperative knee swelling persisted ...

The Australian Arthroplasty Thromboprophylaxis Survey

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: Previous surveys of orthopedic surgeons have shown considerable variation in thromboprophylaxis for venous thromboembolism after joint arthroplasty. This survey aimed to determine the current practice among Australian orthopedic surgeons. A questionnaire regarding the duration, reasons, and methods of chemical and mechanical prophylaxis for hip and knee arthroplasty patients was sent to the 1082 surgeons identified; 593 (55%) members completed the questionnaire. The survey revealed that 98% of surgeons used chemical thromboprophylaxis, mainly low-molecular-weight heparin (84% hip and 79% knee). Those who use low-molecular-weight heparin were more likely to prescribe anticoagulants in fear of litigation (19.2% vs 10.1%, P = .04) and more likely to rely on protocols or guidelines (...

Porous Tantalum Patellar Components in Revision Total Knee Arthroplasty: Minimum 5-Year Follow-Up

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

This study evaluated the midterm outcomes of porous tantalum (PT) patellar components. Twenty-three PT components were used in 6 men and 17 women (average age, 62 years). All patellae had less than 10-mm residual thickness. The PT shell was secured to host bone, and a 3-peg polyethylene component was cemented onto the shell. In 2 patients, the PT component was sutured directly to extensor mechanism. Average follow-up was 7.7 years (range, 5-10 years). At follow-up, the Knee Society scores for pain and function averaged 82.7 and 33.3, respectively, whereas the mean Oxford knee score was 32.6. Four patients underwent revision surgery. Survivorship was 19 (83%) of 23 patients. Porous tantalum patellar components can provide fixation where severe bone loss precludes the use of traditional impl...

Acyclic Acetabular Roof Reconstruction for Severe Superior Segmental Acetabular Bone Loss in 2-Stage Surgery for Infected Hip Arthroplasty

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

We present an illustrative case and the surgical technique required to achieve this. (Source: The Journal of Arthroplasty)

Midterm Results of Optetrak Posterior-Stabilized Total Knee System After 7 to 12 Years in a University Hospital

The Journal of Arthroplasty — Wed, 13 Jul 2011 04:00:00 +0100

Abstract: A clinical study has been carried out on 434 posterior-stabilized knee prostheses (Optetrak; Exactech, Gainesville, Fla) implanted between 1995 and 2000 in a university general hospital by 23 surgeons. At a mean follow-up of 8.8 years, 297 knees in 249 patients were available for review. Average patient age at surgery was 71.8 years. Average body mass index was 28.8 kg/m2. Mean flexion range was 108° .The average knee score (Hospital for Special Surgery) increased from 48 points preoperatively to 86 points (60-97 points) at the final review. Of the patients, 81% had an excellent or good result, 14.9% had a fair result, and 4.1% had a poor result. Using the Kaplan-Meier method, we obtained a 91.3% predicted implant survival at 12 years including septic and aseptic revision in the...

In Reply:

The Journal of Arthroplasty — Tue, 12 Jul 2011 23:00:00 +0100

We appreciate the comments of Dr. Desai regarding our article titled “Computer-assisted total knee arthroplasty for arthritis with extra-articular deformity,” which appeared in the Journal of Arthroplasty (2009;24(8):1164-1169). The purpose of this study was to evaluate the outcome of navigated total knee arthroplasty (TKA) in a large series of arthritic knees with extra-articular deformity . Dr. Desai in his letter has stated that (1) our article claims that extra-articular deformities even at the level of midshaft tibia and/or femur can be corrected with TKA with intra-articular resection and claim to achieve deformity correction without any osteotomy at the level of deformity and only with intraarticular cuts and (2) correction of extra-articular deformity and restoration of mechani...

Interface Micromotion of Uncemented Femoral Components from Postmortem Retrieved Total Hip Replacements

The Journal of Arthroplasty — Mon, 04 Jul 2011 04:00:00 +0100

Abstract: Axial torsional loads representative of gait and stair climbing conditions were applied to transverse sections of 8 uncemented postmortem retrievals and a high-resolution imaging system with digital image correlation was used to measure local micromotion along the bone-implant interface. For 7 components that were radiographically stable, there was limited micromotion for gait loading (1.42 ± 1.33 μm) that increased significantly (P = .0032) for stair climb loading (7.32 ± 9.96 μm). A radiographically loose component had motions on the order of 2.3 mm with gait loading. There was a strong inverse relationship between the amount of bone-implant contact (contact fraction) (P = .001) and micromotion. The uncemented components had greater contact fraction (41.8% ± 14.4% vs 11.5%...

Comparison of Radiographic Alignment of Imageless Computer-Assisted Surgery vs Conventional Instrumentation in Primary Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 04 Jul 2011 04:00:00 +0100

Abstract: A total of 208 patients were enrolled in a multicenter, prospective randomized, institutional review board–approved study that compared preoperative surgical plan to postoperative 2-dimensional radiographic alignment measured by a blinded reviewer for primary total knee arthroplasty (TKA) implanted using computer-assisted surgery (CAS) compared with conventional TKA instrumentation. The results demonstrated a statistically significant improvement in the coronal tibial component alignment (P < .03) and failed to demonstrate a statistically significant improvement in the mechanical axis, femoral coronal/sagittal, and tibial sagittal alignment. Knee Society Score knee and function scores and 6-minute walk test were equivalent between the 2 treatment groups at all postoperative int...

Total Knee Arthroplasty in Patients With Stiff Knees

The Journal of Arthroplasty — Fri, 01 Jul 2011 04:00:00 +0100

Abstract: The purpose of this study was to evaluate the clinical outcome of total knee arthroplasty and analyze the prognostic factors in patients with stiff knees. Thirty-two patients (39 knees) with severe knee arthritis and an arc of motion of 50° or less were treated by total knee arthroplasty. The mean follow-up period was 58 months (range, 24-123 months). The mean arc of motion improved from 35° before the operation to 94° at the time of the latest follow-up (P (Source: The Journal of Arthroplasty)

Letter to the Editor

The Journal of Arthroplasty — Thu, 30 Jun 2011 23:00:00 +0100

We read the article on computer-assisted total knee arthroplasty (TKA) in arthritis with extra-articular deformity with interest. We would like to take this opportunity to congratulate the authors for applying computer-assisted surgery (CAS) in correction of extra-articular deformities. The results that they have obtained with CAS are impressive and 1 step ahead in minimizing human errors in deformity correction with aim toward perfection with the help of navigation. (Source: The Journal of Arthroplasty)

Birmingham Mid-Head Resection Hip Arthroplasty in a Young Man with Gigantism

The Journal of Arthroplasty — Mon, 27 Jun 2011 04:00:00 +0100

We present the case of a young man with Sotos syndrome (cerebral gigantism) with associated extraordinary stature (height, 2.16 m; weight, 157 kg) who underwent Birmingham Mid-Head Resection arthroplasty. The large stature of this patient required a custom manufactured prosthesis (a femoral head 68 mm in diameter with an acetabular cup 76 mm in diameter). We believe this to be the largest metal-on-metal resurfacing articulation and hip arthroplasty reported to date. (Source: The Journal of Arthroplasty)

Assessing Short-Term Functional Outcomes and Knee Alignment of Computer-Assisted Navigated Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 27 Jun 2011 04:00:00 +0100

Abstract: This retrospective study examined the relationship between the mechanical axis of the knee throughout its functional arc and functional outcomes in patients with computer-assisted navigation total knee arthroplasty. Data on final intraoperative functional arc alignment were obtained on 76 patients who had computer-assisted navigation total knee arthroplasty over a 2-year period and correlated with scores from postoperative Short Form 12 and Western Ontario and McMaster Universities functional outcome surveys. No correlation was found between functional arc alignment and outcomes from Western Ontario and McMaster Universities or Short Form 12 surveys; however, subgroup analysis of patients with more than 3° average final intraoperative alignment throughout the functional arc of m...

Comparison of Outcomes After Bilateral Simultaneous Total Knee Arthroplasty Using Gender-Specific and Unisex Knees

The Journal of Arthroplasty — Mon, 27 Jun 2011 04:00:00 +0100

In conclusion, gender-specific knees in female total knee patients showed no advantages over standard unisex knees in terms of clinical or radiologic outcomes. (Source: The Journal of Arthroplasty)

Cost-Effectiveness Analysis of Custom Total Knee Cutting Blocks

The Journal of Arthroplasty — Wed, 15 Jun 2011 04:00:00 +0100

Abstract: The purposes of this study were to examine the cost-effectiveness of this technology and to determine improvements in patient outcome needed to make custom total knee cutting blocks cost-effective. A Markov decision model was used to evaluate the cost-effectiveness of custom cutting blocks compared with traditional instrumentation in total knee arthroplasty. The analysis demonstrates routine use of custom cutting blocks for total knee arthroplasty will not be cost-effective unless it results in a significantly reduced revision rate. The reduction necessary increases with increasing costs for the custom blocks. Further research will be necessary to determine if this can be achieved using custom cutting blocks. Patients, surgeons, payers, and institutions should consider this when ...

Secondary Resurfacing of the Patella After Primary Total Knee Arthroplasty: Does the Anterior Knee Pain Resolve?

The Journal of Arthroplasty — Wed, 15 Jun 2011 04:00:00 +0100

This study highlights that secondary resurfacing is not an always rewarding procedure and patients need to be consulted appropriately with regard to the outcome. (Source: The Journal of Arthroplasty)

Dislocation and Infection After Revision Total Hip Arthroplasty: Comparison Between the First and Multiply Revised Total Hip Arthroplasty

The Journal of Arthroplasty — Wed, 15 Jun 2011 04:00:00 +0100

This study evaluated the correlation between the number of revision THAs and the incidence of these complications. Data were obtained from 749 revision THAs. Average follow-up was 13.2 ± 5.9 years. Patients were grouped as first, second, third, and fourth or greater revision THA. Dislocation rates (5.68%, 7.69%, 8.33%, and 27.45%) and infection rates (1.35%, 1.92%, 2.5%, and 7.84%) in the first, second, third, and fourth or greater groups, respectively, correlated directly with the revision number and were highest (P < .001) in the fourth or greater group. Dislocation and infection are exponentially correlated with the number of revision THA. From the fourth revision onward, those risks are multiplied. (Source: The Journal of Arthroplasty)

Preoperative Fluoroscopic Imaging Reduces Variability of Acetabular Component Positioning

The Journal of Arthroplasty — Wed, 15 Jun 2011 04:00:00 +0100

Abstract: We evaluated the preoperative errors in the pelvic tilt of 249 hips before total hip arthroplasty using fluoroscopic imaging while the patients were in the lateral decubitus position. The mean absolute value errors of the pelvic tilt were 2.94° (SD, 2.92°), 2.49° (SD, 2.68°), and 5.92° (SD, 5.20°) in the coronal, transverse, and sagittal planes, respectively. Such preoperative errors in the pelvic tilt contribute to malpositioning of the acetabular component, as is frequently observed on postoperative radiographs. We reduced the incidence of malpositioning by correcting the errors in the pelvic tilt through repositioning of the operating table using fluoroscopic imaging before surgery. The new technique using fluoroscopic imaging described in this article can be performed w...

Load Dispersion Effects of Acetabular Reinforcement Devices Used in Revision Total Hip Arthroplasty: A Simulation Study Using Finite Element Analysis

The Journal of Arthroplasty — Wed, 15 Jun 2011 04:00:00 +0100

Abstract: Several types of acetabular reinforcement devices are used to prevent the collapse of grafted bone in revision total hip arthroplasty. However, it remains unclear how the stress is reduced by different devices. We used finite element analysis to evaluate 4 types of acetabular reinforcement devices: Kerboull-type device, Burch-Schneider anti-protrusio cage, Mueller ring, and Ganz ring. The control was a socket fixed with bone cement without any reinforcement devices. The stress distribution on the inner surface of each socket was calculated by binarization image processing. For all 4 reinforcement devices, the stress was reduced to less than one-half of that in the control. All the devices were useful for preventing the collapse of bulk bone grafts applied to load-bearing defects....

Patients Prefer A Bicruciate-Retaining or the Medial Pivot Total Knee Prosthesis

The Journal of Arthroplasty — Tue, 14 Jun 2011 23:00:00 +0100

With great enthusiasm, we read “Patients prefer a bicruciate-retaining or the medial pivot total knee prosthesis” (J Arthroplasty 2011;26:224) by Pritchett. We congratulate the author on such a commendable article; however, we are afraid that a few issues must be addressed before the results of the author's work can be properly interpreted. (Source: The Journal of Arthroplasty)

Anterior Dislocation After a Posterior Stabilized Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 06 Jun 2011 04:00:00 +0100

We report an unusual case of anterior dislocation of an 11-year-old posterior stabilized total knee arthroplasty in a 55-year-old woman with rheumatoid arthritis occurred after a slip. (Source: The Journal of Arthroplasty)

Detection of Periprosthetic Osteolysis Around Total Knee Arthroplasties: An In Vitro Study

The Journal of Arthroplasty — Mon, 06 Jun 2011 04:00:00 +0100

Abstract: Periprosthetic osteolysis is a common cause of revision of total knee arthroplasties (TKAs), with plain anteroposterior and lateral (APL) radiographs being the most common method for screening. The aim of this study was to examine the utility of lesion detection and volume appreciation with APL, paired oblique radiographs, and computed tomography. Defects of different sizes were created in 3 cadaveric knees with a cementless TKA in situ and imaged with APL, oblique, and computed tomography modalities. The resultant images were then shown to 3 arthroplasty surgeons, and the absence or presence of lesions, volume size, and confidence in assessment were recorded. The results suggest that the current practice of APL is inferior for the assessment of periprosthetic osteolysis around T...

What Happens at the Adjacent Knee Joint After Total Hip Arthroplasty of Crowe Type III and IV Dysplastic Hips?

The Journal of Arthroplasty — Mon, 06 Jun 2011 04:00:00 +0100

Abstract: We prospectively evaluated 30 hips of 22 patients who had normal knees with a mean age of 53.4 years (range, 38-72 years). In the early postoperative period, genu valgum deformity was observed in all knees. Of 22 patients, 17 complained of severe pain owing to strain in the medial collateral ligament and iliotibial tract. Postoperatively, the ipsilateral extremities of the patients were extended by a mean of 16.5 mm (8-25 mm). Q angles of the patients increased by a mean of 4.4° ± 2.5° (P < .001). Although the Harris hip scores were improved (40.7-87.8 points), postoperative Lysholm-Gillquist knee scores were significantly reduced (92-76 points, P < .001). Reduction of displaced hips into the anatomical hip center and lengthening the extremity despite shortening procedure may ...

Pulmonary Embolism Prophylaxis in More Than 30,000 Total Knee Arthroplasty Patients: Is There a Best Choice?

The Journal of Arthroplasty — Mon, 06 Jun 2011 04:00:00 +0100

Abstract: Prophylaxis for pulmonary embolism (PE) prevention in total knee arthroplasty remains controversial. A joint registry evaluated venous thromboembolism prophylaxis and anesthesia impact on the incidence of PE, fatal PE, and death. Patients received mechanical prophylaxis alone or chemical with or without mechanical prophylaxis. The overall PE incidence was 0.45%; fatal PE, 0.01%; and death, 0.31%. The only significant difference in any outcome was the incidence of PE between Coumadin and mechanical prophylaxis alone. Variables associated with a higher incidence of PE were age, an American Society of Anesthesiologists score of 3 or higher, and the use of general anesthesia. Based on the findings, general anesthesia can be discouraged, and only Coumadin fared better than mechanical ...

Deformation of 1-Piece Metal Acetabular Components

The Journal of Arthroplasty — Mon, 06 Jun 2011 04:00:00 +0100

Abstract: The success of metal bearings is dependent on several parameters. The effects of in vivo forces on the deformation of monoblock acetabular components have yet to be determined. The purpose of our study was to assess the amount of deformation with press-fit fixation of 1-piece metal acetabular components. Four manufacturers provided 1-piece metal acetabular components in each size (30 cups). Testing was conducted using a custom vise to simulate press-fit fixation, and measurements were performed with a Mitutoyo Test device (Aurora, Ill). Previously determined in vivo forces were used in the press-fit simulation. All components deformed under simulated in vivo applied loads. Component deformation ranged from 15 to 300 µm. Larger cups with thinner walls to accommodate larger heads ...

Revision Total Hip Arthroplasty Without Bone Graft of High-Grade Acetabular Defects

The Journal of Arthroplasty — Mon, 06 Jun 2011 04:00:00 +0100

Abstract: Mixed results have been reported with bulk and cancellous bone graft to fill defects during acetabular revision arthroplasty. Jumbo cups have been used to maximize host bone contact, and if adequate initial stability can be achieved, this approach may provide a superior long-term outcome. We retrospectively reviewed a consecutive series of 107 acetabular revisions performed using jumbo cups without bone graft. Bone defects were assessed using a validated radiographic classification system that yielded 64 hips with significant bone defects for inclusion. Mean change in American Academy of Orthopaedic Surgeons lower extremity core and pain scores and in Short Form-12 scores showed increases of 22.01, 37.52, and 17.08 points, respectively. Postoperative radiographs consistently demo...

Computer-Assisted Femoral Head-Neck Osteochondroplasty Using a Surgical Milling Device: An In Vitro Accuracy Study

The Journal of Arthroplasty — Mon, 30 May 2011 04:00:00 +0100

Abstract: Surgical navigation might increase the safety of osteochondroplasty procedures in patients with femoroacetabular impingement. Feasibility and accuracy of navigation of a surgical reaming device were assessed. Three-dimensional models of 18 identical sawbone femora and 5 cadaver hips were created. Custom software was used to plan and perform repeated computer-assisted osteochondroplasty procedures using a navigated burr. Postoperative 3-dimensional models were created and compared with the preoperative models. A Bland-Altmann analysis assessing α angle and offset ratio accuracy showed even distribution along the zero line with narrow confidence intervals. No differences in α angle and offset ratio accuracy (P = 0.486 and P = 0.2) were detected between both observers. Planning an...

Safety and Efficacy of a Rotating-Platform, High-Flexion Knee Design: Three- to Five-Year Follow-Up

The Journal of Arthroplasty — Mon, 30 May 2011 04:00:00 +0100

Abstract: Our hypothesis was that a high-flexion rotating-platform posterior stabilized (RP-PS) design could maximize range of motion (ROM) and improve deep-flexion activities. Eighty-seven consecutive patients (109 knees) with high-flexion RP-PS design were prospectively followed up for a minimum of 3 years. Radiographic and clinical outcomes were analyzed using Knee Society Score criteria and Western Ontario and McMaster Universities Osteoarthritis Index. Good to excellent clinical scores were achieved in 96% of the knees. There were no cases of infection, malalignment, loosening, osteolysis, or spinout. The mean preoperative ROM improved from 110.7° to 124° postoperatively. High-flexion activities such as squatting and kneeling were achieved in 62% and 60% of patients, respectively. H...

Cementless Metasul Metal-On-Metal Total Hip Arthroplasties at 13 Years

The Journal of Arthroplasty — Mon, 30 May 2011 04:00:00 +0100

Abstract: Second-generation metal-on-metal bearings have been used since the late 1980s as alternative bearings to eliminate aseptic loosening due to polyethylene wear. The aim of the present study was to evaluate the long-term results of a series of Metasul (Zimmer GmbH, Winterthur, Switzerland) metal-on-metal total hip arthroplasty (THA). One hundred forty-nine cementless THAs with a 28-mm Metasul articulation were performed in 111 consecutive patients. The results were retrospectively reviewed at 13 years postoperatively. Clinical and radiographic evaluations and implant survivorship were performed. Seven hips (4.7%) were revised. The overall survivorship with revision for any reason as the end point was 0.94. The average Harris hip score was 91.4. Expansive osteolysis was found adjacen...

Accuracy and Precision of Two Computer-Assisted Methods of Radiographic Wear Measurement in Total Hip Arthroplasty

The Journal of Arthroplasty — Mon, 30 May 2011 04:00:00 +0100

Abstract: Roentgen Monographic Analysis Tool (ROMAN) and Hip Analysis Suite (HAS) were used to analyze radiographs of a phantom hip model. Displacements of known magnitude and direction were produced using dial micrometers. Differences between the known displacement and the programs' reported displacement were compared. Hip Analysis Suite was superior with a median error of 0.075 mm (range, 0.019-0.205 mm) compared with 0.137 mm (range, 0.008-0.389 mm) for ROMAN (P = .002). Hip Analysis Suite was also more precise when evaluating intraobserver variability, with a standard deviation between radiographs of 0.007 mm (range, 0.002-0.009 mm), whereas ROMAN's standard deviation was 0.117 mm (range, 0.007-0.153 mm). Repeatability for HAS was 0.019 mm and 0.325 mm for ROMAN. Hip Analysis Suite was...

A Prospective Comparison of Warfarin to Aspirin for Thromboprophylaxis in Total Hip and Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 30 May 2011 04:00:00 +0100

Abstract: Current orthopedic practice requires consideration of contradictory recommendations regarding pulmonary embolism (PE) prevention among patients undergoing total hip arthroplasty (THA) and knee joint arthroplasty (TKA). A total of 696 consecutive patients underwent elective THA or TKA. Two hundred eighty-one patients received PE risk stratification per American Academy of Orthopaedic Surgeons guidelines. Of these patients, 152 standard-risk patients received aspirin, and 129 elevated-risk patients received warfarin. The comparator group of 415 patients received American College of Chest Physicians–recommended warfarin without PE risk stratification. Primary study outcomes were symptomatic PE, deep venous thrombosis, major bleeding, and death. The rate of symptomatic PE and venou...

Impaction Bone Grafting With Proximal and Distal Femoral Arthroplasty

The Journal of Arthroplasty — Mon, 30 May 2011 04:00:00 +0100

We present a consecutive series of patients who underwent proximal or distal femoral reconstructions in combination with impaction bone grafting. The average age was 62 years, and the mean follow-up was 36 months (range, 24-84). No revisions were performed for mechanical failure, and radiographs revealed no evidence of implant loosening. No patient complained of end-of-stem thigh pain. There were 3 failures: 1 for periprosthetic fracture, 1 for instability, and 1 for infection. Impaction bone grafting can be used in combination with proximal and distal femoral arthroplasty to successfully manage cases with extensive bone loss after failed hip and knee arthroplasty. The procedure reconstitutes necessary bone stock, improves stress shielding, and provides immediate fixation in capacious cana...

Midterm Results of Primary Total Hip Arthroplasty Using Highly Cross-Linked Polyethylene: Minimum 7-Year Follow-Up Study

The Journal of Arthroplasty — Mon, 30 May 2011 04:00:00 +0100

Abstract: The purpose of this study was to investigate the results of 113 total hip arthroplasties in 109 patients using highly cross-linked polyethylene (HXLPE) after midterm (minimum 7 years) follow-up retrospectively. The mean age at the time of operation was 57 years. Preoperative diagnosis was osteonecrosis in 81 hips and other diagnosis in 32 hips. There was no component loosening. Acetabular osteolysis was found in 12 hips (10.6 %). Mean linear HXLPE wear rate was 0.031 ± 0.012 mm/y. We analyzed the relationship between HXLPE wear rate and several variables influencing HXLPE wear. Only the cup position was related with wear rate of HXLPE significantly (P < .05). The results of total hip arthroplasties using HXLPE showed excellent results with decreased wear rate and low incidence o...

The Ideal Patient Advocate

The Journal of Arthroplasty — Thu, 26 May 2011 23:00:00 +0100

The “triangle of steel” that allows us as orthopedic surgeons to serve as ideal patient advocates embraces 3 component parts. These are knowledge, responsibility, and ethics. Wisdom transcends knowledge and is the sum of experience, evidence-based research, and reflection. Intuitive responses frequently do not serve either us or our patients well! Carefully constructed research protocols, although sometimes tedious and difficult, serve to eliminate bias from both the surgeon investigator as well as the subject. Financial interests need to be transparent. In the end, data not authority are our best friend. (Source: The Journal of Arthroplasty)

Unexpected Failure of Highly Cross-Linked Polyethylene Acetabular Liner

The Journal of Arthroplasty — Mon, 23 May 2011 04:00:00 +0100

Abstract: Highly cross-linked polyethylene (HXPE) in total hip arthroplasty has been shown to decrease wear rate compared with conventional liner. However, it has some disadvantages in that the mechanical properties cause early failure of the implant. This case report presents an unexpected failure of total hip arthroplasty in a 72-year-old woman that occurred at 20 months postsurgery. Operative findings revealed fracture of superior rim at locking groove of liner. We concluded that the failure was caused by decreased mechanical properties of highly cross-linked polyethylene, less thickness of polyethylene, more vertical cup, and use of large femoral head. (Source: The Journal of Arthroplasty)

Little Clinical Advantage of Modified Watson-Jones Approach Over Modified Mini-Incision Direct Lateral Approach in Primary Total Hip Arthroplasty

The Journal of Arthroplasty — Mon, 23 May 2011 04:00:00 +0100

This study compared the clinical outcomes of total hip arthroplasty using a minimally invasive anterolateral approach with a muscle-sparing technique (modified Watson-Jones approach) and the modified mini-incision direct lateral approach. We randomly assigned 102 patients to the muscle-sparing group (n = 52) or the mini-incision direct lateral group (n = 50). Muscle strength recovery of hip abduction at 6 weeks after surgery was better, and creatine kinase level at 1 day after surgery was lower in the muscle-sparing group than in the mini-incision direct lateral group (P < .01). However, there was no difference in the Harris hip score, pain visual analog scale, the Western Ontario and McMaster Universities Osteoarthritis Index, and Medical Outcomes Study Short Form 36 score between the 2 g...

Management Options for Total Knee Arthroplasty in Osteoarthritic Knees With Extra-Articular Tibial Stress Fractures: A 5-Year Experience

The Journal of Arthroplasty — Mon, 23 May 2011 04:00:00 +0100

We present our learning experience with single-stage modular total knee arthroplasty using stem extenders or plates; with proper planning and additional use of image intensifier, these unique cases can reliably be managed with satisfactory outcomes. (Source: The Journal of Arthroplasty)

Conflict of Interest

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:26 +0100

(Source: The Journal of Arthroplasty)

Inst to Authors

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:26 +0100

(Source: The Journal of Arthroplasty)

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:26 +0100

(Source: The Journal of Arthroplasty)

Masthead

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:26 +0100

(Source: The Journal of Arthroplasty)

Editorial Board

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:26 +0100

(Source: The Journal of Arthroplasty)

Post Damage in Contemporary Posterior-Stabilized Tibial Inserts: Influence of Implant Design and Clinical Relevance

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:22 +0100

Abstract: The mechanisms of damage at the polyethylene post in 3 contemporary tibial insert designs were evaluated and compared with a historical standard (Insall-Burstein II; Zimmer, Warsaw, Ind). One hundred five gamma sterilized posterior-stabilized tibial inserts were revised after an average of 4.7 years (0.05-13.6 years). Retrievals were classified according to their designs: Insall-Burstein II (n = 28); PFC (Johnson & Johnson, Raynham, Mass; n = 30); NexGen (Zimmer; n = 32); and Scorpio (Stryker Orthopaedics, Mahwah, NJ; n = 15). Reasons for revision and patient details were available. Surface damage scoring and photogrammetry were performed on all the retrieved tibial inserts. Oxidation analysis was carried out for traceable historical, gamma air-sterilized and conventional, gamma ...

Intramedullary vs Extramedullary Femoral Alignment Guides: A 15-Year Follow-Up of Survivorship

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:22 +0100

Abstract: The influence of intramedullary (IM) and extramedullary (EM) femoral cutting guides on survivorship of total knee arthroplasty was studied in 6726 total knee arthroplasty guided by either an IM (4993 knees) or EM (1733 knees) system. Fifteen-year survivorship of the 2 cohorts showed no statistically significant difference (EM 97.9% vs IM 98.5%; P = .2500, log rank). Medial bone collapse comprised the highest proportion of all failure modes for both groups (0.35% vs 0.40%, respectively, P = .6731, Cox regression). Mean tibiofemoral (overall) anatomical alignment was statistically more accurate in the IM group (IM 4.6° [±2.2°] valgus vs EM 5.1° [±3.1°] valgus; P < .0001). The mean tibial alignment was 90.5° (±3.0) and 90.3° (±2.2) (P = .0077). The EM group had a significa...

Osteolysis Propensity Among Bilateral Total Hip Arthroplasty Patients

The Journal of Arthroplasty — Thu, 19 May 2011 14:34:21 +0100

Abstract: Because some patients with high wear rates demonstrate extensive osteolysis whereas other patients with similarly high wear rates show little or no evidence of osteolysis, we hypothesized that both polyethylene wear and a patient-specific propensity mediate the development of osteolysis. We evaluated wear and osteolysis using computed tomography and radiographs among 46 patients who had undergone bilateral total hip arthroplasties (THAs). A radiographic patient-specific propensity for osteolysis associated with each THA was quantified by dividing the amount of osteolysis by the volumetric wear. Using a multivariate regression analysis to simultaneously consider the influence of polyethylene wear and patient propensity, we found that both factors are associated with the amount of ...

Randomized Trial of Computer-Assisted Knee Arthroplasty: Impact on Clinical and Radiographic Outcomes

The Journal of Arthroplasty — Wed, 18 May 2011 04:00:00 +0100

Abstract: Computer-assisted surgery in knee arthroplasty is gaining popularity; however, the resulting outcome improvement is controversial. A double-blinded trial was performed with subjects randomized to undergo surgery with either computer-assisted or nonassisted instruments. Postoperatively, limb and implant alignment and rotation were assessed using both full-length radiographs and computed tomography in addition to clinical scores. One hundred twenty patients (141 knees) were randomized. No differences in Western Ontario MacMaster Osteoarthritis Score, Short Form-36, or flexion were seen. More varus limb alignment was seen in the computer-assisted group (1.9°) vs the nonassisted group (0.9°, P = .04) with no improvement in alignment precision. Rotational alignment of the components...

Acetabular Revision Total Hip Arthroplasty Using an Impacted Morselized Allograftand a Cementless Cup: Minimum 10-Year Follow-Up

The Journal of Arthroplasty — Wed, 18 May 2011 04:00:00 +0100

This study was undertaken to analyze the clinical and radiologic results of acetabular revision arthroplasty using an impacted morselized allograft and a cementless cup and was performed on 71 hips of 62 patients who were followed up for a minimum of 10 years (10 years to 14 years 8 months; mean, 12 years). The acetabular bone defects were classified using the American Academy of Orthopaedic Surgeons Committee on the Hip and Paprosky classifications. Cementless hemispherical cups were inserted via a press-fit technique, using an impacted morselized allograft. The mean Harris hip score at the last follow-up visit was 92. Only 3 cases were re-revised, and the 12-year survival rate was thus 95.8%. The study shows that acetabular revision arthroplasty using an impacted morselized allograft and...

Comparison of Surface Characteristics of Retrieved Cobalt-Chromium Femoral Heads With and Without Ion Implantation

The Journal of Arthroplasty — Mon, 16 May 2011 04:00:00 +0100

Abstract: Nitrogen ion implantation of CoCr is reported to produce increased surface hardness and a lower friction surface. Femoral heads with and without ion implantation retrieved from 1997 to 2003 were evaluated for surface roughness (average surface roughness [Ra], mean peak height [Rpm], and maximum distance from peak to valley [Rmax]), nanohardness, and the ion-treated layer thickness. The difference in average Rmax (P = .033) and average Rpm (P = .008) was statistically significant, but there was no correlation between the average or maximum roughness parameters (average surface roughness, Rmax, and Rpm) and time in vivo (P > .05). Overall, nanohardness was greater for the low-friction ion-treated heads (P < .001); and it decreased with increasing time in vivo (P = .01). Ion treatme...

Does a Collar Improve the Immediate Stability of Uncemented Femoral Hip Stems in Total Hip Arthroplasty? A Bilateral Comparative Cadaver Study

The Journal of Arthroplasty — Mon, 16 May 2011 04:00:00 +0100

Abstract: The aim of this study was to compare the immediate stability of collared vs collarless uncemented femoral stems in total hip arthroplasty. A bilateral comparative study of 20 cadavers (40 hips: 20 collarless, 20 collared) was performed. Forces in the vertical and horizontal planes required to initiate subsidence of femoral stem and subsequent femoral fracture were measured. In vertical plane, subsidence began at an average force of 3129 ± 494 N for collarless stems and 6283 ± 3584 N for collared stems (P = .02). Fracture occurred at a significantly higher force for collared stems (P = (Source: The Journal of Arthroplasty)

Serum Metal Ion Concentrations After Unilateral vs Bilateral Large-Head Metal-on-Metal Primary Total Hip Arthroplasty

The Journal of Arthroplasty — Mon, 16 May 2011 04:00:00 +0100

Abstract: It is unknown if the presence of bilateral well-functioning large-head metal-on-metal (MOM) total hip arthroplasties (THAs) leads to higher serum metal ion concentrations than unilateral MOM THA. Elevated levels (chromium, 17 μg/L; cobalt, 19 μg/L) have been associated with poorly functioning MOM THA with metallosis. Fourteen patients having undergone bilateral and 25 patients having undergone unilateral large-head primary MOM THA were compared. Harris Hip Scores, University of California Los Angeles activity scores, radiographs, serum creatinine, and serum cobalt and chromium levels were obtained. Only cobalt ion levels were significantly higher in the bilateral group than in the unilateral group (1.8 μg/L vs 1.0 μg/L, P = .029). Comparatively, this magnitude is clinically r...

Posterior Condyle Surface Damage on Retrieved Femoral Knee Components

The Journal of Arthroplasty — Mon, 16 May 2011 04:00:00 +0100

Abstract: Twenty-two retrieved femoral knee components were identified with posterior condyle surface damage on average at 99° flexion (range, 43°-135° flexion). Titanium alloy material transfer and abrasive surface damage were evident on cobalt-chromium alloy femoral components that were in contact with titanium alloy tibial trays. Surface damage on the retrieved Oxinium femoral components (Smith and Nephew, Inc, Memphis, Tenn) that were in contact with titanium alloy tibial trays showed gouging, associated with the removal and cracking of the oxide and exposure of the zirconium-niobium alloy substrate. Cobalt-chromium alloy femoral components that were in contact with cobalt-chromium alloy tibial trays showed abrasive wear. Contact between the femoral component and tibial tray should ...

Femoral Impaction Grafting in Revision Total Hip Arthroplasty: A Follow-Up of 540 Hips

The Journal of Arthroplasty — Mon, 16 May 2011 04:00:00 +0100

Abstract: Between 1987 and 1999, 540 revision total hip arthroplasties in 487 patients were performed at our institution using the femoral impaction grafting technique with a cemented femoral stem. All patients were prospectively followed up for 2 to 15 years postoperatively with no loss to follow-up. A total of 494 hips remained successfully in situ at an average of 6.7years. The 10-year survival rate was 98.0% (95% confidence interval, 96.2-99.8) with aseptic loosening as the end point and 84.2% (95% confidence interval, 78.5-89.9) for reoperation for any reason. Indication for surgery and the use of any kind of reinforcement significantly influenced outcome (P < .001). This is the largest known series of revision THA with femoral impaction grafting, and the results support continued use...

Revision Total Hip Arthroplasty Using a Tapered, Press-Fit Cementless Revision Stem in Elderly Patients

The Journal of Arthroplasty — Fri, 13 May 2011 04:00:00 +0100

Abstract: In elderly patients, osteoporosis can complicate revision total hip arthroplasty (THA). The SLR-Plus (Smith & Nephew, Memphis, TN) revision stem has a tapered, press-fit design, which we hypothesized could enhance stability in this population. Accordingly, we retrospectively analyzed data for 48 elderly patients who underwent revision THA using the SLR-Plus stem. The patients had a mean age of 66.5 years (range, 60-81 years) at surgery. They were monitored for a mean of 5.6 years (range, 3.4-8.0 years) after surgery. The mean Harris Hip Score improved from 67.8 to 91.6. No infection, dislocation, osteolysis, or stress shielding around stem were observed after surgery. The survivorship at an average of 5.6-year follow-up was 98%. These favorable results indicate that the SLR-Plus ...

Management of a Pelvic Mass Following a Worn Uncemented Total Hip Arthroplasty

The Journal of Arthroplasty — Wed, 11 May 2011 04:00:00 +0100

This article presents the case of a 50 year old woman with history of hip joint trauma and total hip arthroplasty (THA) revisions who presented to her gynecologist with a large intrapelvic cyst. Prolonged use of an indwelling drain and failure to recognize the orthopaedic origin of the mass resulted in articular infection that required an antibiotic spacer and subsequent THA revision. This patient did not have pain or evidence of medial wall defects, but did have a history of trauma, revision arthroplasty and acetabular allograft. In the presence of these findings, wear-induced polyethylene debris should be considered in the differential diagnosis of the pelvic mass. (Source: The Journal of Arthroplasty)

Knee Simulator Wear of Vitamin E Stabilized Irradiated Ultrahigh Molecular Weight Polyethylene

The Journal of Arthroplasty — Wed, 11 May 2011 04:00:00 +0100

Abstract: Wear and damage of ultrahigh molecular weight polyethylene (UHMWPE) tibial inserts used in total knee arthroplasty are accelerated by oxidation. Radiation crosslinking reduces wear but produces residual free radicals adversely affecting stability. One alternative to stabilize radiation-crosslinked UHMWPE is to infuse the material with vitamin E (vit E). We investigated the properties of 100-kGy e-beam–irradiated UHMWPE that was subsequently doped with vitamin E in comparison with conventional UHMWPE. Both polymers were sterilized with gamma irradiation in vacuum packaging. Vitamin E–doped UHMWPE showed lower wear before and after aging (2.4 ± 0.5 and 2.5 ± 0.8 mg/million cycle, respectively, vs 26.9 ± 3.5 and 40.8 ± 3.0 mg/million cycle for conventional UHMWPE). Conventio...

Periacetabular Osteolysis is the Problem in Contemporary Total Hip Arthroplasty in Young Patients

The Journal of Arthroplasty — Wed, 11 May 2011 04:00:00 +0100

Abstract: We retrospectively reviewed 474 patients (492 hips) with a contemporary cemented total hip arthroplasty (THA) (mean age, 38.9 years) and 504 patients (532 hips) with a cementless THA (mean age, 39.3 years). Patients were evaluated clinically and radiographically. The mean follow-up was similar (14.5 vs 14.8 years) in both groups. The mean postoperative Harris hip scores (93.6 vs 94.7 points), the mean Western Ontario and McMaster Universities Osteoarthritis Index scores (12 vs 13 points), and the mean University of California, Los Angeles activity scores (6.9 vs 7.1 points) were similar between the 2 groups. Incidence of acetabular osteolysis (16% vs 20%) and femoral osteolysis (8% vs 9%) was similar between the 2 groups. Survivorship of cup (86% vs 82%) and stem (98% vs 98.5%) w...

Dilute Betadine Lavage Before Closure for the Prevention of Acute Postoperative Deep Periprosthetic Joint Infection

The Journal of Arthroplasty — Wed, 11 May 2011 04:00:00 +0100

This study evaluated the efficacy of a dilute Betadine (Purdue Pharma, Stamford, Conn) lavage in preventing early deep postoperative infection after total hip (THA) and knee (TKA) arthroplasty. A protocol of dilute Betadine lavage (0.35%) for 3 minutes was introduced to the practice of the senior author in June 2008. A total of 1862 consecutive cases (630 THA and 1232 TKA) performed before this were compared with 688 consecutive cases (274 THA and 414 TKA) after for the occurrence of periprosthetic infections within the first 90 days postoperatively. Eighteen early postoperative infections were identified before the use of dilute Betadine lavage, and 1 since (0.97% and 0.15%, respectively; P = .04). There were no significant demographic differences between the 2 groups. Betadine lavage bef...

The Use of a Novel “Conservative Hip Replacement” to Reconstruct an Osteoarthritic Hip With an Occluded Femoral Canal

The Journal of Arthroplasty — Wed, 11 May 2011 04:00:00 +0100

Abstract: This case report describes the successful use of a novel “conservative hip replacement” in conditions precluding the use of a standard total hip arthroplasty in a 70-year-old man. The femoral canal was occluded because of previous surgery for a bone tumor in the subtrochanteric region. The patient continues to do well at 4 years with minimal discomfort. At this interval, the Oxford Hip Score was 35. This conservative hip replacement has been developed to preserve bone stock and produce more physiologic loading of the proximal femur. Its design has been produced, using plain radiographs and computed tomography, to maximize “fit and fill” of the femur. The neck supports standard modular heads, allowing the use of any bearing surface. The prosthesis has been rigorously labor...

Achilles Allograft Reconstruction for Recurrent Dislocation in Total Hip Arthroplasty

The Journal of Arthroplasty — Tue, 10 May 2011 23:00:00 +0100

We describe the use of an Achilles allograft sling to improve hip stability. Eight patients treated with the sling were followed an average of 5 years. Seven patients had no recurrent instability and good postoperative range of motion. One graft failed in a patient with a neuropathic hip. Cadaveric biomechanical testing was also performed to investigate the stiffness and torque to failure of the sling in 6 specimens. Allograft slings can be used to improve hip stability. The technique is relatively easy to perform and does not limit postoperative range of motion. The graft decreases joint stiffness and has a greater torque to failure than the intact capsule. (Source: The Journal of Arthroplasty)

Fixation and Bone Remodeling Around a Low-Modulus Stem: Seven-Year Follow-Up of a Randomized Study With Use of Radiostereometry and Dual-Energy X-Ray Absorptiometer

The Journal of Arthroplasty — Fri, 06 May 2011 04:00:00 +0100

Abstract: Thirty-eight patients (40 hips) randomly received either an uncemented fully porous-coated composite stem (Epoch; Zimmer, Warsaw, Ind) or an uncemented proximally porous-coated solid stem (Anatomic; Zimmer). Patients were followed up for 7 years using radiostereometry, dual-energy x-ray absorptiometry, conventional radiography, the Harris Hip Score, and a pain questionnaire. Both stem designs achieved excellent outcome for fixation (stem subsidence and stem rotations close to zero) and clinical outcome, without any difference between the 2 groups (P > .12). Median wear rates were low despite use of conventionally gamma-sterilized polyethylene. No stem was radiographically loose on the postoperative radiographs. The low-modulus composite stem had positive effects on early proximal...

A Comparison of Wound Closure Techniques for Total Knee Arthroplasty

The Journal of Arthroplasty — Mon, 02 May 2011 04:00:00 +0100

Abstract: Four wound closure techniques for total knee arthroplasty were compared in a prospective, randomized, controlled, institutional review board–approved study with 75 subjects. The study compared tissue adhesives, stapling, and suturing with respect to procedure time and cost, together with functional and clinical outcome. Total knee arthroplasty closure time (capsule to cutaneous) favored staples at 26 s/cm, followed by adhesives (45 and 37 s/cm for 2-octyl and n-butyl-2, respectively) and, finally, subcuticular suturing at 54 s/cm (P < .0007). Reduced procedure time translated into intraoperative cost reduction where closure cost per centimeter was $70, $62, $57, and $75 for 2-octyl, n-butyl-2, staples, and sutures, respectively. No significant differences in infection, dehiscen...

Letter to the Editor

The Journal of Arthroplasty — Sun, 01 May 2011 23:00:00 +0100

With great interest, I read the article by Larson et al (J Arthroplasty. 2010;25(7):). Patients with inheritance of abnormal renal tubular phosphate wasting show bony deformities mostly in the lower extremities . Because of rotational and angular deformities, it is still a challenge for an orthopedic surgeon to correct those deformities to decelerate the development of osteoarthritis. We also reported about a 43-year-old woman with inherited vitamin D–resistant rickets that developed because of multiple deformities and osteoarthritis of the hip and knee joint . She firstly was treated with bilateral total knee arthroplasty (PFC post-stab; DePuy Johnson&Johnson Orthopaedic Inc, Warsaw, Ind). The immediate postoperative outcome was good but showed deterioration at the 12-month follow-up wi...

Bipolar Hip Arthroplasty

The Journal of Arthroplasty — Fri, 29 Apr 2011 04:00:00 +0100

Abstract: Our aim was to compare hip arthroplasty with internal screw fixation in the repair of intertrochanteric fractures in elderly patients with osteoporosis. Of 112 included patient, 70 (81.81 ± 4.88 years) received hip arthroplasty with a prosthesis specially designed for intertrochanteric fractures, and 42 (83.46 ± 5.11 years) underwent plate-screw fixation. The hip arthroplasty group had significantly longer operation time, intraoperative blood loss, and total volume of blood transfused but had shorter time to beginning weight-bearing (5.94 ± 2.76 vs 23.68 ± 22.01 days) and higher postoperative Harris hip score (91.37 ± 4.80 vs 86.14 ± 5.46). In the arthroplasty group, there were 2 dislocations; and in the plate-screw fixation group, there were 5 internal fixation failures. H...

Rotating Platform Spinouts with Cruciate-Retaining Mobile-Bearing Knees

The Journal of Arthroplasty — Thu, 28 Apr 2011 23:00:00 +0100

Abstract: Spinout or dislocation is a complication of mobile-bearing total knee arthroplasty. We have observed this complication in 7 of 1255 cruciate-retaining mobile-bearing total knees (0.56%). Patient factors associated with a spinout included female sex, obesity, and preoperative valgus deformity. Operative treatment was generally successful, but significant complications occurred in 3 of the 7 patients. (Source: The Journal of Arthroplasty)

Fracture of the Outer Metallic Head of the Bipolar Hip Prosthesis: An Unusual Bearing Surface Failure

The Journal of Arthroplasty — Wed, 20 Apr 2011 04:00:00 +0100

We report a case of a fracture of the outer metallic head of a modular cemented bipolar hemiarthroplasty 2 years after the index procedure. Over time, the outer head lost its intended motion and assumed a vertical position. We hypothesized that this position caused asymmetrical loading with stress concentration at the poles, compounded by repeated impingement between the skirted inner cobalt-chromium (Cr-Co) head and the outer stainless steel head of this particular prosthesis. These were supported by the finite element studies. In addition, scanning electron microscopy and energy dispersive x-ray studies showed metallurgical defects that seemed to have initiated and/or accelerated the fracture. Although rare, this mode of failure calls for increased awareness, periodic follow-up, and qual...

In Vivo Knee Kinematics During Stair and Deep Flexion Activities in Patients With Bicruciate Substituting Total Knee Arthroplasty

The Journal of Arthroplasty — Wed, 20 Apr 2011 04:00:00 +0100

Abstract: Orthopedic surgeons and their patients continue to seek better functional outcomes after total knee arthroplasty. The bicruciate substituting (BCS) total knee arthroplasty design has been introduced to achieve more natural knee mechanics. The purpose of this study was to characterize kinematics in knees with BCS arthroplasty during deep flexion and stair activities using fluoroscopy and model-image registration. In 20 patients with 25 BCS knees, we observed average implant flexion of 128° during kneeling and consistent posterior condylar translations with knee flexion. Tibial rotations were qualitatively similar to those observed in the arthritic natural knee. Knee kinematics with BCS arthroplasty were qualitatively more similar to arthritic natural knees than knees with either ...

Preoperative Screening/Decolonization for Staphylococcus aureus to Prevent Orthopedic Surgical Site Infection: Prospective Cohort Study With 2-Year Follow-Up

The Journal of Arthroplasty — Wed, 20 Apr 2011 04:00:00 +0100

Abstract: We quantified surgical site infections (SSIs) after preoperative screening/selective decolonization before elective total joint arthroplasty (TJA) with 2-year follow-up and 2 controls. Concurrent controls (n = 2284) were patients of surgeons not participating in screening/decolonization. Preintervention controls (n = 741) were patients of participating surgeons who underwent TJA the previous year. Staphylococcus aureus nasal carriers (321/1285 [25%]) used intranasal mupirocin and chlorhexidine baths as outpatients. Staphylococcal SSIs occurred in no intervention patients (0/321) and 19 concurrent controls. If all SSIs occurred in carriers and 25% of controls were carriers, staphylococcal SSI rate would have been 3.3% in controls (19/571; P = .001). Overall SSI rate decreased from...

Revision of the Unstable Total Knee Arthroplasty: Outcome Predictors

The Journal of Arthroplasty — Wed, 20 Apr 2011 04:00:00 +0100

Abstract: Revision arthroplasty is often required for confirmed cases of symptomatic tibiofemoral instability after total knee arthroplasty (TKA). We evaluated the results of revision for TKA instability in a consecutive series of 67 patients (68 knees) between 2000 and 2006. Outcome measures were surgeon-based assessment of knee stability, Knee Society Score, and Short Form Health Survey 36. At an average of 39 months of follow-up, the mean Knee Society Score and Short Form Health Survey 36 physical and mental scores were 76, 53, and 67 points, respectively. Knee instability persisted in 14 patients (22%). Data at the 95% confidence level revealed that revising both the femoral and tibial components, the use of femoral augments, and smaller joint line elevation as measured on radiographs ...

Letter to the Editor

The Journal of Arthroplasty — Tue, 19 Apr 2011 23:00:00 +0100

I write to you about the article of Westrich et al (J Arthroplasty 2010;25:1015-1021). The authors write that “with any treatment plan, the goal is to eliminate the infection and reconstruct a functional, stable and painless knee joint.” Everyone will accept this statement. In their article, they claim for a 91% success rate in eradicating the initial infection. However, according to the above statement, eradicating the initial infection is only a part of the complete treatment plan. If I understand properly, the data provided the following: (Source: The Journal of Arthroplasty)

Inflammatory Pseudotumor Complicating Metal-On-Highly Cross-Linked Polyethylene Total Hip Arthroplasty

The Journal of Arthroplasty — Mon, 18 Apr 2011 04:00:00 +0100

We present a case of pseudotumor requiring revision surgery, which occurred uniquely around a metal-on-highly cross-linked polyethylene bearing. (Source: The Journal of Arthroplasty)

Incarceration of a Dislocated Mobile Bearing to the Popliteal Fossa After Unicompartmental Knee Arthroplasty

The Journal of Arthroplasty — Mon, 18 Apr 2011 04:00:00 +0100

Abstract: The mobile meniscal bearing of unicompartmental knee arthroplasty is completely free moving, and dislocation of this bearing is a major concern for all mobile-bearing designs. Most dislocations are located in the intracapsular area; however, posterior dislocation of the polyethylene bearing to an extra-articular area of the knee after unicompartmental arthroplasty has not been previously reported. During a revision surgery, separate incision was necessary to remove a dislocated meniscal bearing in the popliteal fossa. The authors present a case of incarceration of a dislocated mobile bearing to the popliteal fossa after unicompartmental knee arthroplasty that was missed during initial diagnosis. (Source: The Journal of Arthroplasty)

Patellofemoral Function After Total Knee Arthroplasty: Gender-Related Differences

The Journal of Arthroplasty — Mon, 18 Apr 2011 04:00:00 +0100

Abstract: The purpose of the study was to evaluate patellofemoral results in 2 comparable groups of 50 patients, men and women, undergoing total knee arthroplasty. The average follow-up was 6 years. The implant was posteriorly stabilized with a dome patellar arthroplasty. The patients were studied using Knee Society knee and functional scores and the Hospital for Special Surgery (HSS) patellar score. Radiologic study included standard and weight-bearing axial views and a computed tomographic scan to assess component rotation. The 2 groups achieved satisfactory and similar knee scores; women had a significantly lower functional and patellar scores. The incidence of lateral patellar tilt, subluxation, and lateral impingement was decreased in weight-bearing axial views compared with non–wei...

The Journal of Arthroplasty via MedWorm.com

Conflict of Interest

Instructions to Authors

Table of Contents

Masthead

Editorial Board

The 21st Annual Meeting of the American Association of Hip and Knee Surgeons, November 4-6, 2011, Dallas, TX

To Our Dear Friend, Dick Rothman

Conflict of Interest Statement

Instructions to Authors

Contents

Masthead

Editorial Board

A Novel Technique for Femoral Canal Occlusion During Cement Pressurization in Proximal Femoral Arthroplasty

Treatment of Displaced Neck Fractures of the Femur With Total Hip Arthroplasty

Conflict of Interest

Instructions to Authors

Table of Contents

Masthead

Editorial Board

Does a High-Flexion Design Affect Early Outcome of Medial Unicondylar Knee Arthroplasty? Clinical Comparison at 2 Years

New Definition for Periprosthetic Joint Infection

Effect of Pelvic Obliquity on the Orientation of the Acetabular Component in Total Hip Arthroplasty

In Reply:

Effects of Simvastatin on Osseointegration in a Canine Total Hip Arthroplasty Model: An Experimental Study: A Novel Molecular Mechanism

In Reply:

The Use of a Revision Femoral Stem to Manage a Distal Femoral Periprosthetic Fracture in a Well-Fixed Total Knee Arthroplasty

To the Editor:

New Definition for Periprosthetic Joint Infection

Thin Hard Crest on the Edge of Ceramic Acetabular Liners Accelerates Wear in Edge Loading

Conflict of Interest

Instructions to Authors

Table of Contents

Masthead

Editorial Board

Are Acetabular Component Alignment Guides for Total Hip Arthroplasty Accurate?

Letter to the Editor

The Value of Patient-Matched Instrumentation in Total Knee Arthroplasty

Wear of Polyethylene Against Oxidized Zirconium Femoral Components: Effect of Aggressive Kinematic Conditions and Malalignment in Total Knee Arthroplasty

Prospective Results of Uncemented Tantalum Monoblock Tibia in Total Knee Arthroplasty: Minimum 5-Year Follow-up in Patients Younger Than 55 Years

Conflict of Interest

Instructions to Authors

Table of Contents

Masthead

Editorial Board

In Reply

In Reply:

Computer-Assisted Navigation of Total Knee Arthroplasty for Osteoarthritis in a Patient with Severe Posttraumatic Femoral Deformity

Protection of Repaired Patellar Tendons: A Surgical Technique

Early Biological Fixation of Porous Implant Coated With Paste-Retaining Recombinant Bone Morphogenetic Protein 2

Patterns of Osseointegration and Remodeling in Femoral Revision With Bone Loss Using Modular, Tapered, Fluted, Titanium Stems

The Use of Interlocking Prostheses for Both Temporary and Definitive Management of Infected Periprosthetic Femoral Fractures

Ceramic-On-Ceramic Total Hip Arthroplasty in Patients Younger Than 20 Years

Is Intra-Articular Multimodal Drug Injection Effective in Pain Management After Total Knee Arthroplasty? A Randomized, Double-Blinded, Prospective Study

Foreword

Femoral Nerve Compression After Migration of Bone Cement to the Groin After Hip Arthroplasty

Total Hip Arthroplasty Surveillance: When Do We See Our Patients Postoperatively?

A Preclinical Study of Stem Subsidence and Graft Incorporation After Femoral Impaction Grafting Using Porous Hydroxyapatite as a Bone Graft Extender

Total Hip Arthroplasty After Prior Surgical Treatment of Hip Fracture: Is it Always Challenging?

Surgical Repair of the Gluteal Tendons: A Report of 72 Cases

Intramedullary Rod and Cement Static Spacer Construct in Chronically Infected Total Knee Arthroplasty

In Reply:

Conflict of Interest Statement

Instructions to Authors

Table of Contents

Masthead

Editorial Board

Erratum

Retraction Due to Duplication: “Cement Spacer Loaded With Antibiotics for Infected Implants of the Hip Joint”The Journal of Arthroplasty, Volume 24(January 2009), Issue 1, Pages 83-95

Improving Initial Acetabular Component Stability in Revision Total Hip Arthroplasty: Calcium Phosphate Cement vs Reverse Reamed Cancellous Allograft

All-Polyethylene Tibial Implant in Young, Active Patients: A Concise Follow-Up, 10 to 18 years

Results of a Second-Generation Constrained Condylar Prosthesis in Primary Total Knee Arthroplasty

Rehospitalizations, Early Revisions, Infections, and Hospital Resource Use in the First Year After Hip and Knee Arthroplasties

Fungal Periprosthetic Hip and Knee Joint Infections: Clinical Experience With a 2-Stage Treatment Protocol

Long-Term Trends in Hip Arthroplasty Use and Volume

Lateral Laxity in Flexion Increases the Postoperative Flexion Angle in Cruciate-Retaining Total Knee Arthroplasty

Results of Cemented Femoral Revisions for Periprosthetic Femoral Fractures in the Elderly

Greater Satisfaction in Older Patients With a Mobile-Bearing Compared With Fixed-Bearing Total Knee Arthroplasty

To Use or Not to Use Continuous Passive Motion Post–Total Knee Arthroplasty: Presenting Functional Assessment Results in Early Recovery

The Australian Arthroplasty Thromboprophylaxis Survey