Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 468 | Issue 12 | Dec, 2010

In Situ Pinning With Arthroscopic Osteoplasty for Mild SCFE: A Preliminary Technical Report

Michael Leunig MD, Kevin Horowitz MD, Hannes Manner MD, Reinhold Ganz MD

There is emerging evidence that even mild slipped capital femoral epiphysis leads to early articular damage. Therefore, we have begun treating patients with mild slips and signs of impingement with in situ pinning and immediate arthroscopic osteoplasty.

Algorithm for Femoral and Periacetabular Osteotomies in Complex Hip Deformities

Reinhold Ganz MD, Kevin Horowitz MD, Michael Leunig MD

Residual acetabular dysplasia of the hip in most patients can be corrected by periacetabular osteotomy. However, some patients have intraarticular abnormalities causing insufficient coverage, containment or congruency after periacetabular osteotomy, or extraarticular abnormalities that limit either acetabular correction or hip motion. For these patients, we believe an additional proximal femoral osteotomy can improve coverage, containment, congruency and/or motion.

Transtrochanteric Rotational Osteotomy for a Subchondral Insufficiency Fracture of the Femoral Head in Young Adults

Takuaki Yamamoto MD, PhD, Kenyu Iwasaki MD, Yukihide Iwamoto MD, PhD

While subchondral insufficiency fracture of the femoral head is most frequently seen in elderly patients, this fracture has also been reported in some young individuals.

The Repair Process of Osteonecrosis After a Transtrochanteric Rotational Osteotomy

Takuaki Yamamoto MD, PhD, Satoshi Ikemura MD, PhD, Yukihide Iwamoto MD, PhD, Yoichi Sugioka MD, PhD

Many studies have reported the factors influencing the progression of collapse and development of osteoarthritis after a transtrochanteric rotational osteotomy. It is not well understood how the healing process of the osteonecrotic area occurs after this procedure.

Evidence of Reduced Muscle Trauma Through a Minimally Invasive Anterolateral Approach by Means of MRI

Michael Müller MD, Stephan Tohtz MD, Marc Dewey MD, Ivonne Springer MD, Carsten Perka MD

Minimally invasive techniques in THA are intended to minimize periarticular muscle trauma. The lateral approach has a risk of partial gluteal insufficiency, while the anterolateral approach carries the risk of damaging the tensor fasciae latae through intermuscular nerve and compression injury.

Elevation of the Femur in THA Through a Direct Anterior Approach: Cadaver and Clinical Studies

Masanori Matsuura MD, Hirotsugu Ohashi MD, PhD, Yusaku Okamoto MD, PhD, Fumiaki Inori MD, Yoshiaki Okajima MD

The direct anterior approach in THA is an intermuscular approach that requires no muscle detachment. However, it is difficult to elevate the proximal femur for access to the femoral canal.

Function and Fixation of Total Hip Arthroplasty in Patients 25 Years of Age or Younger

John C. Clohisy MD, Jeremy M. Oryhon MD, Thorsten M. Seyler MD, Christopher W. Wells BA, Steve S. Liu MD, John J. Callaghan MD, Michael A. Mont MD

The treatment of end-stage hip disease in very young patients is controversial, with advocates for nonoperative treatment, hip arthrodesis and replacement procedures. The functional improvements in this group of patients are not well documented and whether the condition for which the surgery is performed influences function.

Cemented Hip Designs are a Reasonable Option in Young Patients

Vincent Busch MD, Rik Klarenbeek MD, Tom Slooff MD, PhD, B. Willem Schreurs MD, PhD, Jean Gardeniers MD, PhD

Young patients with degenerative cartilage disease of the hip remain a challenge for the orthopaedic surgeon. Different treatment options are available of which uncemented hips are the most popular owing to long-term concerns about cemented implants. As an alternative, we have used a cemented hip design in combination with bone impaction grafting in patients with acetabular defects.

What is the Midterm Survivorship and Function After Hip Resurfacing?

Luthfur Rahman MRCS, Sarah K. Muirhead-Allwood FRCS, Muhannad Alkinj MBBS

Hip resurfacing arthroplasty is a common procedure that improves functional scores and has a reported survivorship between 95% and 98% at 5 years. However, most studies are reported from the pioneering rather than independent centers or have relatively small patient numbers or less than five years followup. Various factors have been implicated in early failure.

Highly Crosslinked Polyethylene Reduces Wear in Total Hip Arthroplasty at 5 Years

Jonathan Mutimer FRCS (Orth), Peter A. Devane FRACS, Kathryn Adams PhD, J. Geoffrey Horne FRACS

Although hip arthroplasty reliably relieves pain and improves function, problems have arisen with wear and osteolysis. Highly crosslinked polyethylene has been developed to address this problem although at present there is limited clinical evidence it does so longer term.

Incidence and Factors Associated with Squeaking in Alumina-on-Alumina THA

Il-Yong Choi MD, Yee-Suk Kim MD, Kyu-Tae Hwang MD, Young-Ho Kim MD

The alumina-on-alumina bearing surface, which has a high wear resistance and a good biocompatibility, is widely used in THA but recently has been associated with squeaking. While various authors have reported factors associated with squeaking, they remain poorly understood.

Cemented Total Hip Arthroplasty With Subtrochanteric Osteotomy in Dysplastic Hips

Colin R. Howie FRCSEd, Nicholas E. Ohly MRCSEd, Ben Miller FRACS

Total hip arthroplasty (THA) in the presence of developmental dysplasia of the hip (DDH) can be technically challenging. Restoring the anatomic center of hip rotation may require femoral osteotomy. Techniques using cementless components are widely reported but less is known about using cemented components that may be more appropriate with osteopenic bone.

The Use of a Cemented Dual Mobility Socket to Treat Recurrent Dislocation

Moussa Hamadouche MD, PhD, David J. Biau MD, Denis Huten MD, Thierry Musset MD, François Gaucher MD

The treatment of recurrent dislocation after total hip arthroplasty remains challenging. Dual mobility sockets have been associated with a low rate of dislocation but it is not known whether they are useful for treating recurrent dislocation.

Constrained Liner in Neurologic or Cognitively Impaired Patients Undergoing Primary THA

Philippe Hernigou MD, Paolo Filippini MD, Charles-Henri Flouzat-Lachaniette MD, Sobrinho Uirassu Batista MD, Alexandre Poignard MD

THA performed in patients with cognitive deficits or neuromuscular diseases has been associated with a high postoperative dislocation rate. The constrained liner reportedly provides stability in patients with recurrent dislocation. However, achieving stability could be offset by early loosening when used in patients with neurologic diseases.

Combining C-reactive Protein and Interleukin-6 May Be Useful to Detect Periprosthetic Hip Infection

Martin A. Buttaro MD, Ignacio Tanoira MD, Fernando Comba MD, Francisco Piccaluga MD

The sensitivity and specificity to detect periprosthetic infection of the different methods have been questioned, and no single laboratory test accurately detects infection before revision arthroplasty.

What Are the Risk Factors for Infection in Hemiarthroplasties and Total Hip Arthroplasties?

José Cordero-Ampuero MD, PhD, Marisol Dios MD

Late infection is the second most frequent early complication after total hip arthroplasty (THA) and the most frequent after hemiarthroplasty. Known risk factors for infection after THA include posttraumatic osteoarthritis, previous surgery, chronic liver disease, corticoid therapy, and excessive surgical time. However, risk factors for hemiarthroplasty are not clearly established.

Early Reactive Synovitis and Osteolysis after Total Hip Arthroplasty

H. John Cooper MD, Amar S. Ranawat MD, Hollis G. Potter MD, Li Foong Foo MD, MRCP, FRCR, Trevor W. Koob BA, Chitranjan S. Ranawat MD

Little is known about intraarticular pathology following THA prior to the radiographic appearance of osteolysis, primarily due to imaging limitations. MRI has recently been applied to imaging the postarthroplasty hip with the ability to detect periarticular bony and soft tissue pathology; specifically, it is able to detect abnormal synovial patterns and focal bone loss well before the radiographic appearance of osteolysis.

The Fate of Grafting Acetabular Defects During Revision Total Hip Arthroplasty

Nathan A. Mall MD, Ryan M. Nunley MD, Kirk E. Smith BS, William J. Maloney MD, John C. Clohisy MD, Robert L. Barrack MD

Acetabular defects are frequently grafted during revision THA. Previous studies using plain radiographs report high rates of graft incorporation. However, given plain radiographs underestimate osteolysis, it is unclear whether plain radiographs adequately reflect graft fill or incorporation.

Long-term Results for Minor Column Allografts in Revision Hip Arthroplasty

Paul T. H. Lee MB BCh, FRCS (Eng), FRCS (Orth), Guy Raz MD, Oleg A. Safir MD, MED, FRCSC, David J. Backstein MD, MED, FRCSC, Allan E. Gross MD, FRCSC, OOnt

While acetabular structural allografts provide an important alternative for reconstructions, concerns remain with long-term graft resorption, collapse, and failure. Midterm studies of minor column (shelf) allograft suggest reasonable survival but long-term survival is unknown.

The Survival and Fate of Acetabular Reconstruction With Impaction Grafting for Large Defects

Eduardo Garcia-Cimbrelo MD, PhD, Ana Cruz-Pardos MD, PhD, Eduardo Garcia-Rey MD, PhD, EBOT, José Ortega-Chamarro MD

Impaction bone grafting has been used for acetabular reconstruction in revision surgery. However, most series do not establish differences in survival in revisions with differing severity of bone loss.

Reduced Femoral Component Subsidence with Improved Impaction Grafting at Revision Hip Arthroplasty

D. W. Howie MBBS, PhD, FRACS, S. A. Callary BAppSc, M. A. McGee BSc, MPh, N. C. Russell MBBS, BE(Hons), L. B. Solomon MD, PhD, FRACS

Despite stem subsidence being a major complication of femoral impaction bone grafting in cemented revision hip arthroplasty, few studies have distinguished subsidence at the prosthesis-cement interface from that at the cement-bone interface. It is unknown how technique developments intended to improve the procedure influence stability of the stem.

Is There a Risk in Placing a Ceramic Head on a Previously Implanted Trunion?

Didier Hannouche MD, PhD, Jérôme Delambre MD, Frédéric Zadegan MD, Laurent Sedel MD, Rémy Nizard MD, PhD

Strategies for revising a ceramic-on-ceramic total hip prosthesis are controversial. Some consider reimplantation of a ceramic head on a well-fixed femoral stem inadvisable as it may lead to a fracture of the newly implanted head.

Determinants of Pain in Patients with Carpal Tunnel Syndrome

Fiesky Nunez MD, Ana-Maria Vranceanu PhD, David Ring MD, PhD

Carpal tunnel syndrome causes numbness, weakness, and atrophy. Pain without numbness is not characteristic of this disease.

RUNX2 Polymorphisms Associated with OPLL and OLF in the Han Population

Yang Liu MD, Yongfei Zhao MD, Yu Chen MD, Guodong Shi MD, Wen Yuan MD

Runt-related transcription factor 2 (RUNX2), BMP-2, COL6A1, and VDR are four genes that may be related to ossification of the spinal ligament. However, their pathogenetic relevance remains unclear. Most cases of ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) have been reported in Asian populations, but the polymorphic loci in these genes may vary among people of different races.

Modular Necks Improve the Range of Hip Motion in Cases with Excessively Anteverted or Retroverted Femurs in THA

Akinobu Matsushita MD, PhD, Yasuharu Nakashima MD, PhD, Masanori Fujii MD, Taishi Sato MD, Yukihide Iwamoto MD, PhD

Anteversion of an acetabular component often is difficult to ascertain in patients with THA in whom excessively anteverted or retroverted femurs may result in limited ROM or risk of dislocation. Restriction of motion, however, is determined by the combination of version of both components.

A Prospective Randomized Trial of Mini-incision Posterior and Two-incision Total Hip Arthroplasty

Craig J. Della Valle MD, Emily Dittle RN, Mario Moric MS, Scott M. Sporer MD, Asokumar Buvanendran MD

The two-incision approach to THA has been controversial, with some authors reporting its use is associated with a rapid recovery whereas others report no differences in outcomes and a higher risk of perioperative complications secondary to increased surgical complexity.

Ethnic and Gender Differences in the Functional Disparities after Primary Total Knee Arthroplasty

Atul F. Kamath MD, John G. Horneff MD, Vandy Gaffney BA, Craig L. Israelite MD, Charles L. Nelson MD

The benefits of TKA have been well documented. Whether these benefits apply equally across gender and ethnic groups is unclear. Given the underuse of TKA among certain demographic groups, it is important to understand whether gender or ethnicity influence pain and function after TKA.

Does Alignment in the Hindfoot Radiograph Influence Dynamic Foot-floor Pressures in Ankle and Tibiotalocalcaneal Fusion?

Arno Frigg MD, Benno Nigg PhD, Elysia Davis MSc, Beth Pederson MD, V. Valderrabano MD, PhD

The Saltzman-el-Khoury hindfoot alignment view (HAV) is considered the gold standard for assessing the axis from hindfoot to tibia. However, it is unclear whether radiographic alignment influences dynamic load distribution during gait.

Femoral Morphologic Differences in Subtypes of High Developmental Dislocation of the Hip

Haijun Xu MD, Yixin Zhou MD, PhD, Qing Liu MD, Qiheng Tang MD, Jianhua Yin MD

Previous studies show the shape of the femur in developmental dislocation of the hip (DDH) becomes more abnormal with increasing subluxation. Two kinds of high dislocations associated with DDH have been observed in clinical practice, one with (Type C1) and one without (Type C2) a false acetabulum. The presence or absence of a false acetabulum in high dislocated hips is associated with different loading patterns and could influence the development and shape of the proximal femur.

Delayed Foreign-body Reaction to Absorbable Implants in Metacarpal Fracture Treatment

Panagiotis K. Givissis MD, PhD, Stavros I. Stavridis MD, PhD, Panayiotis J. Papagelopoulos MD, PhD, Petros D. Antonarakos MD, PhD, Anastasios G. Christodoulou MD, PhD

First-generation bioabsorbable implants have been associated with a high complication rate attributable to weak mechanical properties and rapid degradation. This has led to the development of stronger devices with improved durability. However, the modern implants have raised concerns about potential late-occurring adverse reactions.

Femoral Insufficiency Fractures Associated with Prolonged Bisphosphonate Therapy

Joseph D. Isaacs MD, Louis Shidiak MD, Ian A. Harris MD, PhD, Zoltan L. Szomor MD, PhD

Emerging evidence has linked the long-term use of bisphosphonates with femoral insufficiency fractures. It has been suggested that the prolonged effect on bone remodeling leads to the accumulation of microfractures and weakening of bone.

Is Surgery Necessary for Femoral Insufficiency Fractures after Long-term Bisphosphonate Therapy?

Yong-Chan Ha MD, Myung-Rae Cho MD, Ki Hong Park MD, Shin-Yoon Kim MD, Kyung-Hoi Koo MD

Prolonged use of bisphosphonates in patients with osteoporosis reportedly induces femoral insufficiency fractures. However, the natural course of these fractures and how to treat them remain unknown.

Sex Differences in Factors Influencing Recovery from Arthroscopic Knee Surgery

Patricia H. Rosenberger PhD, Firdaus S. Dhabhar PhD, Elissa Epel PhD, Peter Jokl MD, Jeannette R. Ickovics PhD

Many factors affect recovery from arthroscopic partial meniscectomy, including patient sex. However, sex differences in time to maximal recovery of knee function and factors influencing differential rates of recovery are unknown.

Bioabsorbable Tricalcium Phosphate Bone Cement Strengthens Fixation of Suture Anchors

Rayshad Oshtory MD MBA, Derek P. Lindsey MS, Nicholas J. Giori MD, PhD, Faisal M. Mirza MD, FRCSC

Failure of suture anchor fixation in rotator cuff repair can occur at different interfaces. Prior studies show fixation at the bone-anchor interface can be augmented using polymethylmethacrylate (PMMA) cement, and screw fixation into bone can be strengthened using bioabsorbable tricalcium phosphate cement.

Case Report: Spinal Anesthesia by Mini-laminotomy for a Patient with Ankylosing Spondylitis who was Difficult to Anesthetize

K. H. Leung MRCS, K. Y. Chiu FRCS, Y. W. Wong FRCS, J. C. Lawmin FFARCSI, FHKCA

Orthopaedic surgeons frequently encounter patients with ankylosing spondylitis who would benefit from various types of lower limb operations; however, some of these patients present challenges for anesthesiologists.

Case Reports: Painful Limbs/Moving Extremities: Report of Two Cases

Tsuyoshi Miyakawa MD, Mitsunori Yoshimoto MD, Tsuneo Takebayashi MD, Toshihiko Yamashita MD

Painful limbs/moving extremities is a relatively rare condition characterized by aching pain in one limb and involuntary movement in the affected fingers or toes. Its pathomechanism is unknown. We report two patients with painful limbs/moving extremities. In one patient with a painful arm and moving fingers, the symptoms were resolved after surgery.

Erratum to: Shoulder Arthroplasties have Fewer Complications than Hip or Knee Arthroplasties in US Veterans

Edward V. Fehringer MD, Ted R. Mikuls MD, MSPH, Kaleb D. Michaud PhD, William G. Henderson PhD, James R. O’Dell MD
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