Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Symposium: Papers Presented at the Hip Society Meetings 2010 32 articles

Articles

A Comparison of Two Implant Systems in Restoration of Hip Geometry in Arthroplasty

Michael J. Archibeck MD, Tamara Cummins RT(R)(ARRT), Joshua Carothers MD, Daniel W. Junick MD, Richard E. White MD

Restoration of hip offset and leg length during THA is often limited by available implant geometries. The recent introduction of femoral components with a modular junction at the base of the neck (two modular junction components) has expanded the options to restore femoral offset and leg length.

Hip Dislocation: Are Hip Precautions Necessary in Anterior Approaches?

Camilo Restrepo MD, S. M. Javad Mortazavi MD, Justin Brothers BS, Javad Parvizi MD FRCS, Richard H. Rothman MD, PhD

In 2005, we reported removal of functional restriction after primary THA performed through the anterolateral approach did not increase the incidence of dislocation.

Markers of Thrombin Generation During Resurfacing and Noncemented Total Hip Arthroplasty: A Pilot Study

Edwin P. Su MD, Nikos Chatzoudis MD, Vasileios Sioros MD, George Go BS, Nigel E. Sharrock BMedSci, MB, ChB

Hip resurfacing arthroplasty (HRA) could be associated with an increased risk of deep vein thrombosis (DVT) compared to traditional noncemented THA because it involves greater dissection, increased kinking and distortion of the femoral vessels, takes longer to perform, and involves insertion of some cement into the femur.

Hard-on-Hard Total Hip Impingement Causes Extreme Contact Stress Concentrations

Jacob M. Elkins MS, Megan K. O’Brien BS, Nicholas J. Stroud BSE, Douglas R. Pedersen PhD, John J. Callaghan MD, Thomas D. Brown PhD

Impingement events, in addition to their role immediately proximate to frank dislocation, hold the potential to damage new-generation hard-on-hard bearings as a result of the relatively unforgiving nature of the materials and designs. Because of the higher stiffness and tighter design tolerances of metal-on-metal and ceramic implants, surgical positioning plausibly has become even more important.

Validity of the Alpha Angle Measurement on Plain Radiographs in the Evaluation of Cam-type Femoroacetabular Impingement

Cefin Barton MB BCh, MRCS (Ed), FRCS (Tr&Orth), Matias J. Salineros MD, Kawan S. Rakhra MD, FRCPC, Paul E. Beaulé MD, FRCSC

Cam-type femoroacetabular impingement is secondary to lack of concavity at the anterosuperior femoral head-neck junction, resulting in reduced femoral head-neck offset and femoral head asphericity. This morphologic deformity can be detected by MRI and plain radiographs and quantified using the alpha angle.

The Otto Aufranc Award: Enhanced Biocompatibility of Stainless Steel Implants by Titanium Coating and Microarc Oxidation

Young Wook Lim MD, Soon Yong Kwon MD, Doo Hoon Sun MD, Yong Sik Kim MD

Stainless steel is one of the most widely used biomaterials for internal fixation devices, but is not used in cementless arthroplasty implants because a stable oxide layer essential for biocompatibility cannot be formed on the surface. We applied a Ti electron beam coating, to form oxide layer on the stainless steel surface. To form a thicker oxide layer, we used a microarc oxidation process on the surface of Ti coated stainless steel. Modification of the surface using Ti electron beam coating and microarc oxidation could improve the ability of stainless steel implants to osseointegrate.

THA After Acetabular Fracture Fixation: Is Frozen Section Necessary?

Robert S. Sterling MD, Erik M. Krushinski MD, Vincent D. Pellegrini MD

Infection is uncommon after THA performed for failed acetabular fracture repair, despite a high reported incidence of culture-positive fixation implants. The use of frozen section analysis at the time of THA after acetabular fracture fixation surgery is unknown.

Ceramic-on-Ceramic Total Hip Arthroplasty: Incidence of Instability and Noise

David Schroder MD, Lindsey Bornstein BA, Mathias P. G. Bostrom MD, Bryan J. Nestor MD, Douglas E. Padgett MD, Geoffrey H. Westrich MD

Alternative bearing materials in THA have been developed to reduce the incidence of osteolysis. Alumina-on-alumina bearings exhibit extremely low wear rates in vitro, but concerns exist regarding component impingement with the potential for dislocation and the occurrence of noise.

Incidence of Postthrombotic Syndrome in Patients Undergoing Primary Total Hip Arthroplasty for Osteoarthritis

Steven J. Fitzgerald MD, Christopher M. McAndrew MD, Matthew J. Kraay MD, Victor M. Goldberg MD

Postthrombotic syndrome (PTS) is a chronic condition in the lower extremity that develops after deep vein thrombosis (DVT). The incidence of PTS after total hip arthroplasty (THA) is not well established.

Acetabular UHMWPE Survival and Wear Changes With Different Manufacturing Techniques

John B. Meding MD, E. Michael Keating MD, Kenneth E. Davis MS

Polyethylene wear may be affected by the type of polyethylene resin, manufacturing technique, degree of thermal stabilization, and sterilization technique.

Perivascular Lymphocytic Infiltration Is Not Limited to Metal-on-Metal Bearings

Vincent Y. Ng MD, Adolph V. Lombardi MD, Keith R. Berend MD, Michael D. Skeels DO, Joanne B. Adams BFA

Perivascular lymphocytic infiltration (PVLI) suggests an adaptive immune response. Metal hypersensitivity after THA is presumed associated with idiopathic pain and aseptic loosening, but its incidence and relationship to metallic wear leading to revision are unclear as are its presence and relevance in non-metal-on-metal arthroplasty.

Large Acetabular Defects Can be Managed with Cementless Revision Components

E. Scott Paxton MD, James A. Keeney MD, William J. Maloney MD, John C. Clohisy MD

Optimal techniques for acetabular revision in the setting of major pelvic osteolysis have not been established. Bilobed components, structural grafts, and reinforcement cages have demonstrated 10–24% midterm failure rates. While cementless hemispherical components have been utilized to treat large acetabular defects, most reports have not focused specifically on patients with extensive deficiencies.

Modular Femoral Stems for Revision Total Hip Arthroplasty

Camilo Restrepo MD, Magdalena Mashadi MD, Javad Parvizi MD, FRCS, Matthew S. Austin MD, William J. Hozack MD

Modular femoral stems are one option for revision THA surgeons and allow offset restoration, leg length discrepancy correction, and stability independent of distal stem fixation. The complexity of revision THA usually leads surgeons to use multiple revision hip designs to address these issues.

What Factors Influence Long-term Survivorship After Hip Arthroscopy?

Joseph C. McCarthy MD, Bryan T. Jarrett BS, Olumide Ojeifo BS, Jo Ann Lee MS, Charles R. Bragdon PhD

Hip arthroscopy is an evolving procedure. One small study suggested that a low modified Harris hip score and arthritis at the time of surgery were predictors of poor prognosis.

Wear versus Thickness and Other Features of 5-Mrad Crosslinked UHMWPE Acetabular Liners

Fu-Wen Shen PhD, Zhen Lu PhD, Harry A. McKellop PhD

The low wear rates of crosslinked polyethylenes provide the potential to use larger diameters to resist dislocation. However, this requires the use of thinner liners in the acetabular component, with concern that higher contact stresses will increase wear, offsetting the benefits of the crosslinking.

Hip Offset in Total Hip Arthroplasty: Quantitative Measurement with Navigation

Manish Dastane MD, Lawrence D. Dorr MD, Rupesh Tarwala MD, Zhinian Wan MD

Offset in THA correlates to abductor muscle function, wear, and impingement. Femoral offset after THA is not independent of the cup center of rotation (COR) so hip offset, a combination of femoral offset and change in hip COR, becomes the important measurement.

Improving Cup Positioning Using a Mechanical Navigation Instrument

Simon D. Steppacher MD, Jens H. Kowal PhD, Stephen Barry Murphy MD

Although surgical navigation reduces the rate of malpositioned acetabular cups in total hip arthroplasty (THA), its use has not been widely adopted. As a result of our perceived need for simple and efficient methods of navigation, we developed a mechanical navigation device for acetabular cup orientation.

Retrieved Highly Crosslinked UHMWPE Acetabular Liners Have Similar Wear Damage as Conventional UHMWPE

David T. Schroder MD, Natalie H. Kelly BS, Timothy M. Wright PhD, Michael L. Parks MD

Highly crosslinked UHMWPE is associated with increased wear resistance in hip simulator and clinical studies. Laboratory and case studies, however, have described rim fracture in crosslinked acetabular liners. Controversy exists, therefore, on the relative merits of crosslinked liners over conventional liners in terms of wear performance versus resistance to fatigue cracking.

Does a Cemented Cage Improve Revision THA for Severe Acetabular Defects?

Erik Hansen MD, David Shearer MD, MPH, Michael D. Ries MD

Evidence suggests a growing incidence of revision total hip arthroplasty (THA) including a subset with large acetabular defects. Revision THA for severe acetabular bone loss is associated with a relatively high rate of mechanical failure.

Bernese Periacetabular Osteotomy in Males: Is There an Increased Risk of Femoroacetabular Impingement (FAI) After Bernese Periacetabular Osteotomy?

K. Ziebarth MD, J. Balakumar MBBS, FRACS (Orth), S. Domayer MD, Y. J. Kim MD, PhD, M. B. Millis MD

The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients.

Bisphosphonate Remains Highly Localized After Elution From Porous Implants

Kimberly McKenzie MEng, J. Dennis Bobyn PhD, Jacintha Roberts MEng, Dorota Karabasz BSc, Michael Tanzer MD

Local elution of zoledronic acid from a porous implant reportedly enhances periimplant bone formation and implant fixation. However, there is no information in the literature on the extent to which eluted bisphosphonate remains localized around the implant or becomes systemically distributed.

Hospital Economics of Primary THA Decreasing Reimbursement and Increasing Cost, 1990 to 2008

Adam J. Rana MD, Richard Iorio MD, William L. Healy MD

The introduction of new technology has increased the hospital cost of THA. Considering the impending epidemic of hip osteoarthritis in the United States, the projections of THA prevalence, and national cost-containment initiatives, we are concerned about the decreasing economic feasibility of hospitals providing THA.

Modular Femoral Sleeve and Stem Implant Provides Long-term Total Hip Survivorship

David Le MD, Karen Smith CRA, Dylan Tanzer, Michael Tanzer MD

A femoral implant with a modular sleeve and stem has been designed to allow independent and complete metaphyseal-diaphyseal fit and fill as well as independent rotation to accommodate anteversion at the time of THA.

Acetabular Component Positioning Using the Transverse Acetabular Ligament: Can You Find It and Does It Help?

Noah J. Epstein MD, Steven T. Woolson MD, Nicholas J. Giori MD

Several studies have reported that the transverse acetabular ligament (TAL) can be used to orient the acetabular component during total hip arthroplasty and that it can be identified in nearly all patients.

Quality of Life Following Proximal Femoral Replacement Using a Modular System in Revision THA

Muhyeddine M. Al-Taki MD, Bassam A. Masri MD, Clive P. Duncan MD, MSc, Donald S. Garbuz MD, MHSc

Proximal femoral replacement using a segmental modular system is one option for revision THA in the presence of severe bone loss or periprosthetic fracture. While many papers report function in these patients, they do not describe the quality of life.

The Frank Stinchfield Award: The Impact of Socioeconomic Factors on Outcome After THA: A Prospective, Randomized Study

R. Allen Butler MD, Seth Rosenzweig MD, Leann Myers PhD, Robert L. Barrack MD

Most studies of total hip arthroplasty (THA) focus on the effect of the type of implant on the clinical result. Relatively little data are available on the impact of the patient’s preoperative status and socioeconomic factors on the clinical results following THA.

The Incidence of Acetabular Osteolysis in Young Patients With Conventional versus Highly Crosslinked Polyethylene

Nathan A. Mall MD, Ryan M. Nunley MD, Jin Jun Zhu MD, PhD, William J. Maloney MD, Robert L. Barrack MD, John C. Clohisy MD

Osteolysis is a major mode of hip implant failure. Previous literature has focused on the amount of polyethylene wear comparing highly crosslinked polyethylene (HXPLE) with conventional liners but has not clarified the relative incidence of osteolysis with these two liners.

Patient Perceived Outcomes After Primary Hip Arthroplasty: Does Gender Matter?

Carlos J. Lavernia MD, Jose C. Alcerro MD, Juan S. Contreras MD, Mark D. Rossi PhD

Total hip arthroplasty (THA) provides high functional scores and long-term survivorship. However, differences in function and disability between men and women before and after arthroplasty are not well understood.

A Monoblock Porous Tantalum Acetabular Cup Has No Osteolysis on CT at 10 Years

Todd C. Moen MD, Raju Ghate MD, Noel Salaz BA, Jason Ghodasra BA, S. David Stulberg MD

Aseptic osteolysis has been the single most important factor limiting the longevity of a THA. A great deal of attention has been focused on the development of implants and materials that minimize the development of osteolysis. The monoblock porous tantalum acetabular cup was designed to minimize osteolysis, but whether it does so is unclear.

The John Charnley Award: Risk Factors for Cup Malpositioning: Quality Improvement Through a Joint Registry at a Tertiary Hospital

Mark C. Callanan MA, Bryan Jarrett BS, Charles R. Bragdon PhD, David Zurakowski PhD, Harry E. Rubash MD, Andrew A. Freiberg MD, Henrik Malchau MD, PhD

Few studies have examined factors that affect acetabular cup positioning. Since cup positioning has been linked to dislocation and increased bearing surface wear, these factors affecting cup position are important considerations.

Tranexamic Acid Reduces Allogenic Transfusion in Revision Hip Arthroplasty

Shahryar Noordin MB, BS, Terrence S. Waters MD, Donald S. Garbuz MD, MHSc, Clive P. Duncan MD, MSc, Bassam A. Masri MD

Revision THA is associated with high blood loss and a high probability of blood transfusion in the perioperative period. In November 2003, government legislation established the Blood Utilization Program at our center to reduce the rate and risks associated with allogenic transfusion.