Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Complications of Hip Arthroplasty 17 articles


Failed Metal-on-Metal Hip Arthroplasties: A Spectrum of Clinical Presentations and Operative Findings

James A. Browne MD, C. Dustin Bechtold MD, Daniel J. Berry MD, Arlen D. Hanssen MD, David G. Lewallen MD

A number of recent reports have described novel failure mechanisms of metal-on-metal bearings in total and resurfacing hip arthroplasty. Hip arthroplasties with metal-on-metal articulations are also subject to the traditional methods of failure seen with different bearing couples. There is currently little information in the literature to help guide timely clinical evaluation and management of these patients.

Incidence of Lateral Femoral Cutaneous Nerve Neuropraxia After Anterior Approach Hip Arthroplasty

Krista Goulding MD, Paul E. Beaulé MD, FRCSC, Paul R. Kim MD, FRCSC, Anna Fazekas MA

Although injury to the lateral femoral cutaneous nerve (LFCN) is a known complication of anterior approaches to the hip and pelvis, no study has quantified its’ incidence in anterior arthroplasty procedures.

Reduced Articular Surface of One-piece Cups: A Cause of Runaway Wear and Early Failure

William L. Griffin MD, Christopher J. Nanson MD, Bryan D. Springer MD, Matthew A. Davies PhD, Thomas K. Fehring MD

Despite the clinical success of modern metal-on-metal articulations, concerns with wear-related release of metal ions persist. Evidence suggests metal ion release is related to the effective coverage of the head in the metal shell (the cup’s functional articular arc). A recent study suggests a reduced functional articular arc is associated with increased ion release and the arc is a function of component design, size, and the abduction angle.

Histological Features of Pseudotumor-like Tissues From Metal-on-Metal Hips

Pat Campbell PhD, Edward Ebramzadeh PhD, Scott Nelson MD, Karren Takamura BA, Koen Smet MD, Harlan C. Amstutz MD

Pseudotumor-like periprosthetic tissue reactions around metal-on-metal (M-M) hip replacements can cause pain and lead to revision surgery. The cause of these reactions is not well understood but could be due to excessive wear, or metal hypersensitivity or an as-yet unknown cause. The tissue features may help distinguish reactions to high wear from those with suspected metal hypersensitivity.

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

Timothy M. DiIorio BS, Peter F. Sharkey MD, Agnes M. Hewitt MD, Javad Parvizi MD

Postoperative nausea and vomiting (PONV) is frequent after joint arthroplasty; in addition to causing patient distress, it interferes with early mobilization and hospital discharge. Various antiemetic agents reduce PONV, but their action is limited by a short half-life. Aprepitant, an antiemetic developed for patients receiving chemotherapy, has a duration of action much longer than other antiemetics.

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Robert B. Bartelt MD, Brandon J. Yuan MD, Robert T. Trousdale MD, Rafael J. Sierra MD

Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon.

Factors That Predict Short-term Complication Rates After Total Hip Arthroplasty

Nelson F. SooHoo MD, Eugene Farng MD, Jay R. Lieberman MD, Lauchlan Chambers MD, David S. Zingmond MD, PhD

There remains uncertainty regarding the relative importance of patient factors such as comorbidity and provider factors such as hospital volume in predicting complication rates after total hip arthroplasty (THA).

Squeaking in Metal-on-Metal Hip Resurfacing Arthroplasties

Christina Esposito BSc, William L. Walter MBBS, FRACS (Orth), PhD (Surg), Pat Campbell PhD, Anne Roques PhD

While most reports of audible squeaking in total hip arthroplasty (THA) have focused on ceramic bearings, squeaking can occur in metal-on-metal bearings and may be an important clinical complication to consider during patient followup.

Retrospective Analysis of Infection Rate After Early Reoperation in Total Hip Arthroplasty

Hussein Darwiche MD, Wael K. Barsoum MD, Alison Klika MS, Viktor E. Krebs MD, Robert Molloy MD

Infection is a devastating complication of total hip arthroplasty (THA). Unavoidable reoperation during the acute recovery phase of hip arthroplasty has the potential for an increased infection rate but the risk is not well established nor is the fate of these infected hips.

Intraoperative Femur Fracture is Associated with Stem and Instrument Design in Primary Total Hip Arthroplasty

Keith R. Berend MD, Adolph V. Lombardi MD, FACS

Intraoperative proximal femoral fracture is a risk in total hip arthroplasty (THA) with cementless stems with reported rates of 1.5–27.8%. Certain designs or designs associated with certain types of instrumentation may have higher rates.

Do the Potential Benefits of Metal-on-Metal Hip Resurfacing Justify the Increased Cost and Risk of Complications?

Kevin J. Bozic MD, MBA, Christine M. Pui MD, Matthew J. Ludeman PhD, Thomas P. Vail MD, Marc D. Silverstein MD

Metal-on-metal hip resurfacing arthroplasty (MoM HRA) may offer potential advantages over total hip arthroplasty (THA) for certain patients with advanced osteoarthritis of the hip. However, the cost effectiveness of MoM HRA compared with THA is unclear.

Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty

Bradley P. Graw MD, Steven T. Woolson MD, Heather G. Huddleston MD, Stuart B. Goodman MD, PhD, James I. Huddleston MD

Minimal incision total hip arthroplasty (MI THA) techniques were developed to decrease postoperative pain and recovery time. Although these techniques have increased in popularity, the long-term survivorship of these procedures is unknown.

Early Experience with a Novel Nonmetallic Cable in Reconstructive Hip Surgery

Nicholas T. Ting BA, Glenn D. Wera MD, Brett R. Levine MD, Craig J. Della Valle MD

Metallic wires and cables are commonly used in primary and revision THA for fixation of periprosthetic fractures and osteotomies of the greater trochanter. These systems provide secure fixation and high healing rates but fraying, third-body generation, accelerated wear of the bearing surface, and injury to the surgical team remain concerning.

Risk of Complication and Revision Total Hip Arthroplasty Among Medicare Patients with Different Bearing Surfaces

Kevin J. Bozic MD, MBA, Kevin Ong PhD, Edmund Lau MS, Steven M. Kurtz PhD, Thomas P. Vail MD, Harry E. Rubash MD, Daniel J. Berry MD

To address the long-term problems of bearing surface wear and osteolysis associated with conventional metal-polyethylene (M-PE) total hip arthroplasty (THA), metal-metal (M-M), and ceramic-ceramic (C-C) bearings have been introduced. These bearing surfaces are associated with unique risks and benefits and higher costs. However the relative risks of these three bearings in an older population is unknown.

Natural History of Squeaking after Total Hip Arthroplasty

Camilo Restrepo MD, Wadih Y. Matar MD, MSc, FRCSC, Javad Parvizi MD, FRCS, Richard H. Rothman MD, PhD, William J. Hozack MD

In recent years, a number of alternative bearing surfaces, such as ceramic on ceramic, are being used in THA. Squeaking after THA is a recently recognized complication; however, its incidence is unknown.

Should Gram Stains Have a Role in Diagnosing Hip Arthroplasty Infections?

Aaron J. Johnson MD, Michael G. Zywiel MD, D. Alex Stroh BS, David R. Marker BS, Michael A. Mont MD

The utility of Gram stains in diagnosing periprosthetic infections following total hip arthroplasty has recently been questioned. Several studies report low sensitivity of the test, and its poor ability to either confirm or rule out infection in patients undergoing revision total hip arthroplasty. Despite this, many institutions including that of the senior author continue to perform Gram stains during revision total hip arthroplasty.