Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2015 Hip Society Proceedings 18 articles


Adverse Reactions to Metal on Metal Are Not Exclusive to Large Heads in Total Hip Arthroplasty

Adolph V. Lombardi MD, Keith R. Berend MD, Joanne B. Adams BFA, Keri L. Satterwhite

There is some suggestion that smaller diameter heads in metal-on-metal total hip arthroplasty (MoM THA) may be less prone to the adverse reactions to metal debris (ARMD) seen with large-diameter heads.

Planar dGEMRIC Maps May Aid Imaging Assessment of Cartilage Damage in Femoroacetabular Impingement

Evgeny Bulat MA, Sarah D. Bixby MD, Carl Siversson PhD, Leslie A. Kalish ScD, Simon K. Warfield PhD, Young-Jo Kim MD, PhD

Three-dimensional (3-D) delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) helps quantify biochemical changes in articular cartilage that correlate with early-stage osteoarthritis. However, dGEMRIC analysis is performed slice by slice, limiting the potential of 3-D data to give an overall impression of cartilage biochemistry. We previously developed a computational algorithm to produce unfolded, or “planar,” dGEMRIC maps of acetabular cartilage, but have neither assessed their application nor determined whether MRI-based grading of cartilage damage or dGEMRIC measurements predict intraoperative findings in hips with symptomatic femoroacetabular impingement (FAI).

Total Hip Arthroplasty After Acetabular Fracture Is Associated With Lower Survivorship and More Complications

Zachary Morison MSc, Dirk Jan F. Moojen MD, PhD, Aaron Nauth MD, Jeremy Hall MD, Michael D. McKee MD, James P. Waddell MD, Emil H. Schemitsch MD

Despite modern fracture management techniques allowing for near anatomic reduction of acetabular fractures, there continues to be a risk of posttraumatic arthritis and need for total hip arthroplasty (THA). Few well-controlled studies have compared THA after acetabular fractures with THAs performed for other indications in terms of survivorship or complications, and none, to our knowledge, present 10-year survivorship data in this setting.

Can a Conical Implant Successfully Address Complex Anatomy in Primary THA? Radiographs and Hip Scores at Early Followup

Quoqiang Zhang MD, Stuart B. Goodman MD, PhD, William J. Maloney MD, James I. Huddleston MD

Total hip arthroplasty (THA) in patients with small or abnormal proximal femoral anatomy is challenging as a result of complex anatomic deformities in the hip. It is unclear which stem is the most appropriate for these patients. One possible implant design that may help meet this need is the modified Wagner Cone prosthesis, whose design consists of monoblock cone with splines; however, to our knowledge, no clinical results have been published using this implant.

Is There a Benefit to Modularity in ‘Simpler’ Femoral Revisions?

James I. Huddleston MD, Matthew W. Tetreault MD, Michael Yu MD, Hany Bedair MD, Viktor J. Hansen MD, Ho-Rim Choi MD, Stuart B. Goodman MD, PhD, Scott M. Sporer MD, Craig J. Della Valle MD

Modular revision femoral components allow the surgeon to make more precise intraoperative adjustments in anteversion and sizing, which may afford lower dislocation rates and improved osseointegration, but may not offer distinct advantages when compared with less expensive monoblock revision stems.

Backside Wear Is Not Dependent on the Acetabular Socket Design in Crosslinked Polyethylene Liners

Kamal Bali MBBS, MS, DNB, Richard W. McCalden MD, MPhil, FRCSC, Douglas D. R. Naudie MD, FRCSC, Steven J. MacDonald MD, FRCSC, Matthew G. Teeter PhD

Although it is understood that backside damage occurs in polyethylene acetabular liners, the effect of highly crosslinked polyethylene, which has completely replaced conventional polyethylene, has yet to be examined.

Otto Aufranc Award: Large Heads Do Not Increase Damage at the Head-neck Taper of Metal-on-polyethylene Total Hip Arthroplasties

Georgios K. Triantafyllopoulos MD, Marcella E. Elpers BS, Jayme C. Burket PhD, Christina I. Esposito PhD, Douglas E. Padgett MD, Timothy M. Wright PhD

Fretting and corrosion at head-neck junctions of total hip arthroplasties (THAs) have been associated with adverse local tissue reactions in patients with both metal-on-polyethylene (MoP) and metal-on-metal (MoM) prostheses. Femoral head size contributes to the severity of fretting and corrosion in large-diameter MoM THAs, but its impact on such damage in MoP THAs remains unknown.

Can Radiographs Predict the Use of Modular Stems in Developmental Dysplasia of the Hip?

Christopher L. Peters MD, Jesse Chrastil MD, Gregory J. Stoddard MPH, MBA, Jill A. Erickson PA-C, Mike B. Anderson MSc, Christopher E. Pelt MD

Abnormal anatomy frequently results in the use of a modular stem in patients undergoing primary total hip arthroplasty (THA) for developmental dysplasia of the hip (DDH). However, because these stems are not always available in the operating room, it would be helpful if standard radiographic views could be analyzed in such a way that patients whose femoral anatomy might call for stem modularity could be anticipated before surgery. To our knowledge, no such parameters have been defined.

What Safe Zone? The Vast Majority of Dislocated THAs Are Within the Lewinnek Safe Zone for Acetabular Component Position

Matthew P. Abdel MD, Philipp Roth MD, Matthew T. Jennings BS, Arlen D. Hanssen MD, Mark W. Pagnano MD

Numerous factors influence total hip arthroplasty (THA) stability including surgical approach and soft tissue tension, patient compliance, and component position. One long-held tenet regarding component position is that cup inclination and anteversion of 40° ± 10° and 15° ± 10°, respectively, represent a “safe zone” as defined by Lewinnek that minimizes dislocation after primary THA; however, it is clear that components positioned in this zone can and do dislocate.

No Difference in Reoperations at 2 Years Between Ceramic-on-metal and Metal-on-metal THA: A Randomized Trial

C. Anderson Engh MD, Supatra Sritulanondha MPH, Abigail Korczak RN, Terrence David Whalen BS, DC, Douglas D. R. Naudie MD, Richard W. McCalden MD, Steven J. MacDonald MD

Hard-on-hard bearings for total hip arthroplasty continue to warrant analysis even though crosslinked polyethylene is performing very well. Ceramic-on-metal (CoM) has low in vitro wear and did well in an early clinical trial. We report on a prospective, randomized, multicenter investigational device trial comparing CoM with metal-on-metal (MoM).

High Rates of Interest in Sex in Patients With Hip Arthritis

Carlos J. Lavernia MD, Jesus M. Villa MD

Being sexually active has been associated with a high quality of life. Unfortunately, the topic of sexual limitations in patients undergoing total hip arthroplasty (THA) has not been well studied.

Polyethylene Liner Dissociation Is a Complication of the DePuy Pinnacle Cup: A Report of 23 Cases

Andrew Yun MD, Emmanuel N. Koli MD, John Moreland MD, Richard Iorio MD, John F. Tilzey MD, J. Wesley Mesko MD, Gwo-Chin Lee MD, Mark Froimson MD

Polyethylene liner dissociation is a rare but catastrophic event in total hip arthroplasty (THA), and certain implant designs are known to be at greater risk. Although the DePuy Pinnacle (Warsaw, IN, USA) modular acetabular construct has an excellent record of fixation and wear, an unexpectedly high number of liner dissociations has been noted.

The 2015 Frank Stinchfield Award: Radiographic Abnormalities Common in Senior Athletes With Well-functioning Hips but Not Associated With Osteoarthritis

Lucas A. Anderson MD, Mike B. Anderson MSc, Ashley Kapron PhD, Stephen K. Aoki MD, Jill A. Erickson PA-C, Jesse Chrastil MD, Ramon Grijalva MD, Christopher Peters MD

It is not known whether morphological abnormalities of the hip are compatible with lifelong hip function and avoidance of osteoarthritis (OA). Our purpose was to investigate the prevalence of radiographic findings consistent with femoroacetabular impingement (FAI) and dysplasia (DDH) in senior athletes with well-functioning hips.

John Charnley Award: Preoperative Patient-reported Outcome Measures Predict Clinically Meaningful Improvement in Function After THA

Jonathan L. Berliner MD, Dane J. Brodke BA, Vanessa Chan MPH, Nelson F. SooHoo MD, Kevin J. Bozic MD, MBA

Despite the overall effectiveness of total hip arthroplasty (THA), a subset of patients remain dissatisfied with their results because of persistent pain or functional limitations. It is therefore important to develop predictive tools capable of identifying patients at risk for poor outcomes before surgery.

Wear and Osteolysis of Highly Crosslinked Polyethylene at 10 to 14 Years: The Effect of Femoral Head Size

Paul F. Lachiewicz MD, Elizabeth S. Soileau BSN, John M. Martell MD

Highly crosslinked polyethylene (XLPE) was introduced to decrease periprosthetic osteolysis related to polyethylene wear, a major reason for revision of total hip arthroplasty. However, there are few reports of wear and osteolysis at 10 years postoperatively.

What Can We Learn From 20-year Followup Studies of Hip Replacement?

Christopher T. Martin MD, John J. Callaghan MD, Yubo Gao PhD, Andrew J. Pugely MD, Steve S. Liu MD, Lucian C. Warth MD, Devon D. Goetz MD

A patient who dies during the followup period of a study about total hip arthroplasty (THA) cannot subsequently undergo a revision. The presence of competing events (such as deaths, in a study on implant durability) violates an assumption of the commonly used Kaplan-Meier (KM) survivorship approach. In that setting, KM-based estimates of revision frequencies will be high relative to alternative approaches that account for competing events such as cumulative incidence methods. However, the degree to which this difference is clinically relevant, and the degree to which it affects different ages of patient cohorts, has been poorly characterized in orthopaedic clinical research.

Promising Mid-term Results With a Cup-cage Construct for Large Acetabular Defects and Pelvic Discontinuity

Tomas Amenabar MD, Wael A. Rahman MD, Bandar M. Hetaimish MD, Paul R. Kuzyk MD, Oleg A. Safir MD, Allan E. Gross MD

Restoring normal anatomy and achieving stable fixation of the acetabular component can be especially challenging when the surgeon must deal with severe acetabular defects and/or pelvic discontinuity. The cup-cage (CC) construct, where an ilioischial cage is cemented within a biologically fixed porous metal cup, has emerged as an excellent option to treat such challenges.