Symposium: Complications of Hip Arthroplasty 17 articles
Failed Metal-on-Metal Hip Arthroplasties: A Spectrum of Clinical Presentations and Operative Findings
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.
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.
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.
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?
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.
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.
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).
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.
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
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?
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 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.
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
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.
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.
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.