Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Hip 725 articles


Overdiagnosis of Pulmonary Embolism: Evaluation of a Hypoxia Algorithm Designed to Avoid This Catastrophic Problem

Brian S. Winters MD, Mark Solarz MD, Christina L. Jacovides BS, James J. Purtill MD, Richard H. Rothman MD, PhD, Javad Parvizi MD, FRCS

We observed a substantial increase in the incidence of pulmonary embolism (PE) after total joint arthroplasty (TJA) when multidetector computerized tomography (MDCT) replaced ventilation-perfusion (V/Q) scans as the diagnostic modality of choice. We questioned whether this resulted from the detection of clinically unimportant PE with the more sensitive MDCT and in 2007 instituted a hypoxia protocol to enhance the detection of PE.

Can a Periarticular Levobupivacaine Injection Reduce Postoperative Opiate Consumption During Primary Hip Arthroplasty?

Terence P. Murphy MCh, Damien P. Byrne PhD, Paul Curtin MCh, Joseph F. Baker MCh, Kevin J. Mulhall FRCS (Tr and Orth)

Several reports have confirmed the ability of intraoperative periarticular injections to control pain after THA. However, these studies used differing combinations of analgesic agents and the contribution of each, including the local anesthetic agent, is uncertain. Understanding the independent effects of the various agents could assist in improved pain management after surgery.

Is an Algorithmic Approach to the Treatment of Recurrent Dislocation After THA Effective?

Ehsan Saadat MD, Glenn Diekmann MD, Steven Takemoto PhD, Michael D. Ries MD

The indications for surgical techniques for treatment of recurrent hip dislocation after THA differ, and their rates of achievement of stability may not be similar.

Bony Impingement Limits Design-related Increases in Hip Range of Motion

Adam Bunn BS, Clifford W. Colwell MD, Darryl D. D’Lima MD, PhD

Factors affecting risk for impingement and dislocation can be related to the patient, implant design, or surgeon. While these have been studied independently, the impact of each factor relative to the others is not known.

Aberrant Femoral Torsion Presenting with Frog-leg Squatting Mimicking Gluteal Muscle Contracture

Chia-Ling Chiang MD, Meng-Yuan Tsai MD, Wei-Ning Chang MD, Clement Kuen-Huang Chen MD

Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture.

Multilevel Surgery Improves Gait in Spastic Hemiplegia But Does Not Resolve Hip Dysplasia

Erich Rutz MD, Elyse Passmore MEng, Richard Baker PhD, H. Kerr Graham MD

Multilevel orthopaedic surgery may improve gait in Type IV hemiplegia, but it is not known if proximal femoral osteotomy combined with adductor release as part of multilevel surgery in patients with hip dysplasia improves hip development.

Polyethylene Wear is Related to Patient-specific Contact Stress in THA

Robert Košak MD, PhD, Veronika Kralj-Iglič PhD, Aleš Iglič PhD, Matej Daniel PhD

General numerical models of polyethylene wear and THA simulators suggest contact stresses influence wear. These models do not account for some patient-specific factors. Whether the relationship between patient-specific contact stress and wear apply in vivo is unclear.

Ceramic Bearings for Total Hip Arthroplasty Have High Survivorship at 10 Years

James A. D’Antonio MD, William N. Capello MD, Marybeth Naughton BS

Ceramic bearings were introduced to reduce wear and increase long-term survivorship of total hip arthroplasty. In a previous study comparing ceramic with metal-on-polyethylene at 5 to 8 years, we found higher survivorship and no osteolysis for the ceramic bearings.

Surgical Technique: A Cup-in-Cup Technique to Restore Offset in Severe Protrusio Acetabular Defects

Thomas J. Blumenfeld MD, William L. Bargar MD

Severe medial and/or superior defects encountered in revision THA are currently managed with jumbo (≥ 66 mm) acetabular components and modular augments, with reconstruction cages, or with the cup-cage technique. Preoperative planning can indicate when these techniques may not restore vertical and horizontal offset. Failure to restore offset can lead to impingement, leg length inequality, abductor weakness, and dislocation.

Low Incidence of Groin Pain and Early Failure with Large Metal Articulation Total Hip Arthroplasty

John B. Meding MD, Lindsey K. Meding, E. Michael Keating MD, Michael E. Berend MD

Large-diameter metal-on-metal articulations reportedly improve stability and wear in THAs. However, some reports suggest some patients have unexplained hip and early failures with these implants. Thus, the potential benefits may be offset by these concerns. However, the incidence of these problems is not clearly established.