Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hip 723 articles

Articles

Surgical Risks and Costs of Care are Greater in Patients Who Are Super Obese and Undergoing THA

Menachem M. Meller MD, PhD, Nader Toossi MD, Mark H. Gonzalez MD, PhD, Min-Sun Son PhD, Edmund C. Lau MS, Norman Johanson MD

Patients with morbid obesity, defined as a BMI greater than 40 kg/m, and super obesity, defined as a BMI greater than 50 kg/m, increasingly present for total hip replacement. There is disagreement in the literature whether these individuals have greater surgical risks and costs for the episode of care, and the magnitude of those risks and costs. There also is no established threshold for obesity as defined by BMI in identifying increased complications, risks, and costs of care. Until recently, analysis of higher BMI data was limited to small cohorts from hospital-based data banks, based on BMI or height and weight only, often as part of a multivariate analysis. On October 1, 2010 the Centers for Medicare & Medicaid Services added a fifth digit to the BMI data, V85.xx, in the Medicare data bank, which allowed data mining of cases of patients with higher BMI. To our knowledge, our study is the first large retrospective Medicare data mining study, which allows us to examine BMI levels greater than 40 and 50 kg/mto delineate risks, complications, and costs for these patients.

Increased Hip Stresses Resulting From a Cam Deformity and Decreased Femoral Neck-Shaft Angle During Level Walking

K. C. Geoffrey Ng MASc, Giulia Mantovani PhD, Mario Lamontagne PhD, Michel R. Labrosse PhD, Paul E. Beaulé MD, FRCSC

It is still unclear why many individuals with a cam morphology of the hip do not experience pain. It was recently reported that a decreased femoral neck-shaft angle may also be associated with hip symptoms. However, the effects that different femoral neck-shaft angles have on hip stresses in symptomatic and asymptomatic individuals with cam morphology remain unclear.

A Resident-led Initiative Improves Screening and Treatment for Vitamin D Deficiency in Patients with Hip Fractures

Drew A. Lansdown MD, Amanda Whitaker MD, Rosanna Wustrack MD, Aenor Sawyer MD, Erik N. Hansen MD

Acute hip fractures carry a high risk of morbidity and are associated with low vitamin D levels. Improvements in screening and treating low vitamin D levels may lead to lower fall rates and a lower likelihood of additional fragility fractures. However, patients with low vitamin D levels often remain unassessed and untreated, even after they experience these fractures.

What Risks are Associated with Primary THA in Recipients of Hematopoietic Stem Cell Transplantation?

Brian P. Chalmers MD, Cameron K. Ledford MD, Joseph M. Statz MD, Tad M. Mabry MD, Arlen D. Hanssen MD, Matthew P. Abdel MD

As patients who receive hematopoietic stem cell transplantation are at increased risk of avascular necrosis (AVN) and subsequent degenerative arthritis, THA may be considered in some of these patients, particularly as overall patient survival improves for patients undergoing stem-cell transplants. Patients receiving hematopoietic stem cell transplantation theoretically are at increased risk of experiencing complications, infection, and poorer implant survivorship owing to the high prevalence of comorbid conditions, immunosuppressive therapy regimens including corticosteroids, and often low circulating hematopoietic cell lines; however, there is a paucity of studies elucidating these risks.

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.

Is Botulinum Toxin Type A a Valuable Adjunct During Femoral Lengthening? A Randomized Trial

Hoon Park MD, Soowan Shin BS, Han Sol Shin MD, Hyun Woo Kim MD, Dong Wook Kim MD, Dong Hoon Lee MD, PhD

Reduced joint ROM and distraction-induced pain are common complaints of patients who have undergone gradual femoral lengthening. Attempts to reduce the effects of lengthening on joint motion have included the use of botulinum toxin to reduce the muscle forces that restrict motion. The benefits of this approach during femoral lengthening, however, have not been conclusively established.

What is the Prevalence of Radiographic Hip Findings Associated With Femoroacetabular Impingement in Asymptomatic Asian Volunteers?

Taesoo Ahn MD, Chul-Ho Kim MD, Tae Hyung Kim MD, Jae Suk Chang MD, PhD, Mi Yeon Jeong RN, Kekatpure Aditya DNB, Pil Whan Yoon MD, PhD

Morphologic features of the proximal femur reminiscent of those seen in patients with femoroacetabular impingement (FAI) have been reported among asymptomatic individuals in Western populations, but whether this is the case in Asian populations is unknown.

T1ρ Hip Cartilage Mapping in Assessing Patients With Cam Morphology: How Can We Optimize the Regions of Interest?

Helen Anwander MD, Kawan S. Rakhra MD, Gerd Melkus PhD, Paul E. Beaulé MD

T1ρ MRI has been shown feasible to detect the biochemical status of hip cartilage, but various region-of-interest strategies have been used, compromising the reproducibility and comparability between different institutions and studies.

Does Surgeon Experience Impact the Risk of Complications After Bernese Periacetabular Osteotomy?

Eduardo N. Novais MD, Patrick M. Carry BA, Lauryn A. Kestel BS, Brian Ketterman BS, Christopher M. Brusalis BA, Wudbhav N. Sankar MD

Bernese periacetabular osteotomy (PAO) is a technically challenging procedure with potential risk for major complications and a previously reported steep learning curve. However, the impact of contemporary hip preservation fellowships on the learning curve of PAO has not been established.