Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: 2016 Hip Society Proceedings 12 articles

Articles

Reconstruction of the Shallow Acetabulum With a Combination of Autologous Bulk and Impaction Bone Grafting Fixed by Cement

Masaaki Maruyama MD, PhD, Shinji Wakabayashi MD, PhD, Hiroshi Ota MD, PhD, Keiji Tensho MD, PhD

Acetabular bone deficiency, especially proximal and lateral deficiency, is a difficult technical problem during primary total hip arthroplasty (THA) in developmental dysplasia of the hip (DDH). We report a new reconstruction method using a medial-reduced cemented socket and additional bulk bone in conjunction with impaction morselized bone grafting (additional bulk bone grafting method).

Do Bone Graft and Cracking of the Sclerotic Cavity Improve Fixation of Titanium and Hydroxyapatite-coated Revision Implants in an Animal Model?

Brian Elmengaard MD, PhD, Joergen Baas MD, PhD, Thomas Jakobsen MD, PhD, Soren Kold MD, PhD, Thomas B. Jensen MD, PhD, Joan E. Bechtold PhD, Kjeld Soballe MD, DSc

We previously introduced a manual surgical technique that makes small perforations (cracks) through the sclerotic bone shell that typically forms during the process of aseptic loosening (“crack” revision technique). Perforating just the shell (without violating the proximal cortex) can maintain overall bone continuity while allowing marrow and vascular elements to access the implant surface. Because many revisions require bone graft to fill defects, we wanted to determine if bone graft could further increase implant fixation beyond what we have experimentally shown with the crack technique alone. Also, because both titanium (Ti6Al4V) and hydroxyapatite (HA) implant surfaces are used in revisions, we also wanted to determine their relative effectiveness in this model.

What Is the Natural History of Asymptomatic Pseudotumors in Metal-on-metal THAs at Mid-term Followup?

Sujith Konan MBBS, MD (res), FRCS(Tr&Orth), Clive P. Duncan MD, MSc, FRCSC, Bassam S. Masri MD, FRCSC, Donald S. Garbuz MD, MSc, FRCSC

The risk of early revision because of pseudotumors in patients who have undergone large-head metal-on-metal (MoM) total hip arthroplasty (THA) is well documented. However, the natural history of asymptomatic pseudotumors or of MoM articulations without pseudotumors is less well understood. The aim of our study was to investigate the natural history of primary MoM THA at mid-term followup.

One-stage Revision With Catheter Infusion of Intraarticular Antibiotics Successfully Treats Infected THA

Leo A. Whiteside MD, M. E. Roy PhD

Two-stage revision surgery for infected total hip arthroplasty (THA) is commonly advocated, but substantial morbidity and expense are associated with this technique. In certain cases of infected THA, treatment with one-stage revision surgery and intraarticular infusion of antibiotics may offer a reasonable alternative with the distinct advantage of providing a means of delivering the drug in high concentrations.

Two- to 4-Year Followup of a Short Stem THA Construct: Excellent Fixation, Thigh Pain a Concern

Richard L. Amendola MS, Devon D. Goetz MD, Steve S. Liu MD, John J. Callaghan MD

Short stem cementless femoral components were developed to aid insertion through smaller incisions, preserve metaphyseal bone, and potentially decrease or limit the incidence of thigh pain. Despite some clinical success, the senior author (DDG) believed a higher percentage of his patients who had received a cementless short stem design were experiencing thigh pain, which, coupled with concerns about bone ingrowth fixation, motivated the review of this case series.

Otto Aufranc Award: A Multicenter, Randomized Study of Outpatient versus Inpatient Total Hip Arthroplasty

Nitin Goyal MD, Antonia F. Chen MD, MBA, Sarah E. Padgett PA-C, Timothy L. Tan MD, Michael M. Kheir MD, Robert H. Hopper PhD, William G. Hamilton MD, William J. Hozack MD

Length of stay after total hip arthroplasty (THA) has decreased over the last two decades. However, published studies that have examined same-day and early discharge protocols after THA have been done in highly selected patient groups operated on by senior surgeons in a nonrandomized fashion without control subjects.

No Correlation Between Serum Markers and Early Functional Outcome After Contemporary THA

Kirsten L. Poehling-Monaghan MD, Michael J. Taunton MD, Atul F. Kamath MD, Robert T. Trousdale MD, Rafael J. Sierra MD, Mark W. Pagnano MD

Serum markers of inflammation and muscle damage have shown clinical utility in some areas of medicine, but their value in determining the invasiveness or in predicting the early functional outcomes after total hip arthroplasty (THA) has not been demonstrated.

Survivorship of the Bernese Periacetabular Osteotomy: What Factors are Associated with Long-term Failure?

Joel Wells MD, MPH, Michael Millis MD, Young-Jo Kim MD, PhD, Evgeny Bulat MA, Patricia Miller MS, Travis Matheney MD

The Bernese periacetabular osteotomy (PAO) continues to be a commonly performed nonarthroplasty option to treat symptomatic developmental hip dysplasia, but there are few long-term followup studies evaluating results after PAO.

Poor Survivorship and Frequent Complications at a Median of 10 Years After Metal-on-Metal Hip Resurfacing Revision

Gulraj S. Matharu BSc (Hons), MRCS, MRes, Hemant G. Pandit DPhil, FRCS (Tr & Orth), David W. Murray MD, FRCS (Orth)

High short-term failure rates have been reported for several metal-on-metal hip resurfacing (MoMHR) designs. Early observations suggested that MoMHRs revised to total hip arthroplasties (THAs) for pseudotumor had more major complications and inferior patient-reported outcomes compared with other revision indications. However, little is known about implant survivorship and patient-reported outcomes at more than 5 years after MoMHR revision.

The Frank Stinchfield Award

William W. Schairer MD, Joseph M. Lane MD, David A. Halsey MD, Richard Iorio MD, Douglas E. Padgett MD, Alexander S. McLawhorn MD, MBA

Hip fractures are a major public health concern. For displaced femoral neck fractures, the needs for medical services during hospitalization and extending beyond hospital discharge after total hip arthroplasty (THA) may be different than the needs after THA performed for osteoarthritis (OA), yet these differences are largely uncharacterized, and the Medicare Severity Diagnosis-Related Groups system does not distinguish between THA performed for fracture and OA.

The John Charnley Award: Redefining the Natural History of Osteoarthritis in Patients With Hip Dysplasia and Impingement

Cody C. Wyles BS, Mark J. Heidenreich MD, Jack Jeng MD, Dirk R. Larson MD, Robert T. Trousdale MD, Rafael J. Sierra MD

Structural hip deformities including developmental dysplasia of the hip (DDH) and femoroacetabular impingement (FAI) are thought to predispose patients to degenerative joint changes. However, the natural history of these malformations is not clearly delineated.