Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hip 725 articles

Articles

Alloy Microstructure Dictates Corrosion Modes in THA Modular Junctions

Robin Pourzal PhD, Deborah J. Hall BS, Jonas Ehrich BS, Stephanie M. McCarthy BS, Mathew T. Mathew PhD, Joshua J. Jacobs MD, Robert M. Urban

Adverse local tissue reactions (ALTRs) triggered by corrosion products from modular taper junctions are a known cause of premature THA failure. CoCrMo devices are of particular concern because cobalt ions and chromium-orthophosphates were shown to be linked to ALTRs, even in metal-on-polyethylene THAs. The most common categories of CoCrMo alloy are cast and wrought alloy, which exhibit fundamental microstructural differences in terms of grain size and hard phases. The impact of implant alloy microstructure on the occurring modes of corrosion and subsequent metal ion release is not well understood.

What Should Define Preoperative Anemia in Primary THA?

Mitchell R. Klement MD, Ashwin Peres-Da-Silva BS, Brian T. Nickel MD, Cynthia L. Green PhD, Samuel S. Wellman MD, David E. Attarian MD, Michael P. Bolognesi MD, Thorsten M. Seyler MD, PhD

The use of tranexamic acid (TXA) in THA decreases the risk of transfusion after surgery. However, nearly 10% of patients still undergo a transfusion, which has been independently associated with an increased risk of complications. Preoperative anemia has been proven to be a strong predictor of transfusion after THA, but the ideal “cutoff” values in today’s population that maximize sensitivity and specificity to predict transfusion have yet to be established.

What Factors Predict Conversion to THA After Arthroscopy?

John M. Redmond MD, Asheesh Gupta MD, Kevin Dunne BA, Ammar Humayun MBBS, Leslie C. Yuen BA, Benjamin G. Domb MD

Failure of hip preservation to alleviate symptoms potentially subjects the patient to reoperation or conversion surgery to THA, adding recovery time, risk, and cost. A risk calculator using an algorithm that can predict the likelihood that a patient who undergoes arthroscopic hip surgery will undergo THA within 2 years would be helpful, but to our knowledge, no such tool exists.

Current Pathologic Scoring Systems for Metal-on-metal THA Revisions are not Reproducible

Christiaan Smeekes MD, Arjen H. G. Cleven MD, PhD, Bart C. H. Wal MD, PhD, Stefan V. Dubois MD, Remigio W. Rouse MD, Bastiaan F. Ongkiehong MD, Ron Wolterbeek MD, Rob G. H. H. Nelissen MD, PhD

The aseptic lymphocyte vasculitis-associated lesion (ALVAL) score and the modified Oxford ALVAL score are frequently used scoring methods to evaluate the morphologic features of periprosthetic tissues around metal-on-metal (MoM) hip implants. Except for the initial studies of these two morphology scoring methods, to our knowledge, no other studies have reported on intraclass correlation coefficient (ICC) values for interobserver reliability of these scoring methods.

Similar Clinical Outcomes with Preoperative and Postoperative Start of Thromboprophylaxis in THA: A Register-based Study

Pål O. Borgen MD, Are H. Pripp PhD, Eva Dybvik PhD, Lilian Leistad PhD, Ola E. Dahl MD, PhD, Olav Reikerås MD, PhD

Elective THA is associated with a high risk of thromboembolic events. Although these events may be less common now than they were in the past, they can be serious, and most patients undergoing the procedure therefore still receive thromboprophylaxis. However, controversy remains regarding whether to begin thromboprophylaxis before THA or after to best balance the risks of clotting and bleeding.

Does the Risk of Rerevision Vary Between Porous Tantalum Cups and Other Cementless Designs After Revision Hip Arthroplasty?

Inari Laaksonen MD, PhD, Michelle Lorimer BSc, Kirill Gromov MD, PhD, Ola Rolfson MD, PhD, Keijo T. Mäkelä MD, PhD, Stephen E. Graves MD, DPhil, Henrik Malchau MD, PhD, Maziar Mohaddes MD, PhD

Earlier results with porous tantalum acetabular cups in revision THA generally have been favorable. Recently there has been some evidence presented that porous tantalum cups might decrease the risk of rerevision in the setting of revision hip surgery performed owing to prosthetic joint infection (PJI). As the data supporting this assertion come from a study with a limited study population, examining this issue with a large registry approach may be enlightening.

Complete Circumferential Osseous Extension in the Acetabular Rim Occurs Regardless of Acetabular Coverage

Keisuke Watarai MD, Fumihiko Kimura MD, Yuho Kadono MD, PhD, Yoon Taek Kim MD, PhD, Mamoru Niitsu MD, PhD, Hiromi Oda MD, PhD, Hirohiko Azuma MD, PhD

Complete circumferential osseous extension in the acetabular rim has been reported to occur in the deep hip with pincer impingement. However, this phenomenon occasionally is observed in dysplastic hips without pincer impingement, and the degree to which this finding might or might not be associated with hip pain, and how often it occurs bilaterally among patients, are not well characterized.

Increase in Total Joint Arthroplasty Projected from 2014 to 2046 in Australia: A Conservative Local Model With International Implications

Maria C. S. Inacio PhD, Stephen E. Graves MBBS, DPhil, Nicole L. Pratt PhD, Elizabeth E. Roughead PhD, Szilard Nemes PhD

The incidence of joint arthroplasty is increasing worldwide. International estimates of future demand for joint arthroplasty have used models that propose either an exponential future increase, despite obvious system constraints, or static increases, which do not account for past trends. Country-specific projection estimates that address limitations of past projections are necessary. In Australia, a high-income country with the 7th highest incidence of TKA and 15th highest incidence of THA of the Organization for Economic Cooperation and Development (OECD) countries, the volume of TKAs and THAs increased 198% between 1994 and 2014.

Free Vascularized Fibular Grafting Improves Vascularity Compared With Core Decompression in Femoral Head Osteonecrosis: A Randomized Clinical Trial

Lu Cao MD, Changan Guo MD, Jifei Chen MD, Zenggan Chen MD, Zuoqin Yan MD

Management of osteonecrosis of the femoral head remains challenging. Core decompression and free vascularized fibular grafting are commonly used surgical procedures for treatment of osteonecrosis of the femoral head. Few studies, however, have compared these two procedures in a randomized controlled study, in terms of improved vascularity of the femoral head, progression of disease, or hip scores.

Do Surgeon Expectations Predict Clinically Important Improvements in WOMAC Scores After THA and TKA?

Hassan M. K. Ghomrawi PhD, MPH, Carol A. Mancuso MD, Allison Dunning MS, Alejandro Gonzalez Della Valle MD, Michael Alexiades MD, Charles Cornell MD, Thomas Sculco MD, Matthias Bostrom MD, David Mayman MD, Robert G. Marx MD, Geoffrey Westrich MD, Michael O’Dell MD, Alvin I. Mushlin MD

Failure of THA or TKA to meet a patient’s expectations may result in patient disappointment and litigation. However, there is little evidence to suggest that surgeons can consistently anticipate which patients will benefit from those interventions.