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 7 | Jul, 2010

Editorial: A Paucity of Women Among Residents, Faculty, and Chairpersons in Orthopaedic Surgery

Lam Nguyen BS, Nirav H. Amin MD, Thomas P. Vail MD, Ricardo Pietrobon MD, PhD, MBA, Anand Shah MD, MPH

Gender Differences in the Correlation between Symptom and Radiographic Severity in Patients with Knee Osteoarthritis

Hyung Joon Cho MD, Chong Bum Chang MD, Jae Ho Yoo MD, Sung Ju Kim MS, Tae Kyun Kim MD

The effects of gender on the relationship between symptom manifestations and radiographic grades of knee osteoarthritis are not well understood.

Influence of Gender on Age of Treatment with TKA and Functional Outcome

Brian S. Parsley MD, Roberto Bertolusso MA, Melvyn Harrington MD, Adam Brekke BA, Philip C. Noble PhD

Previous studies suggest differences may exist between men and women in terms of knee function before and after total knee replacement. This may be related to the efficacy of the procedure itself or to differences in the severity of disability of male and female patients at the time of surgery.

Prevalence and Predictors of Osteoporosis Risk in Orthopaedic Patients

Tamara D. Rozental MD, Jalaal Shah BS, Aron T. Chacko BS, David Zurakowski PhD

Current physician practices are not effective in adequately evaluating and treating patients for osteoporosis. While dual-energy xray absorptiometry is the gold standard in evaluating bone mineral density, calcaneal quantitative ultrasound has emerged as a low-risk and low-cost alternative.

Comparison of 5766 Vertebral Compression Fractures Treated With or Without Kyphoplasty

Jay M. Zampini MD, Andrew P. White MD, Kevin J. McGuire MD

The majority of the 700,000 osteoporotic vertebral compression fractures (VCFs) that occur annually in the United States affect women. The total treatment costs exceed $17 billion and approximate the total costs of breast cancer ($13 billion) and heart disease ($19 billion). Balloon-assisted percutaneous vertebral augmentation with bone cement (kyphoplasty) reportedly reduces VCF-related pain and accelerates return of independent functional mobility. Kyphoplasty may decrease overall cost of VCF treatment costs by reducing use of posttreatment medical resources.

Pelvic Fractures in Women of Childbearing Age

Lisa K. Cannada MD, Jennifer Barr MD

Pelvic fractures represent major injury. Women of childbearing age who have sustained pelvic fractures question whether they can have children and what type of delivery will be possible.

Incidence of Joint Hypermobility Syndrome in a Military Population: Impact of Gender and Race

Danielle L. Scher MD, Brett D. Owens MD, Rodney X. Sturdivant PhD, Jennifer Moriatis Wolf MD

Joint hypermobility syndrome is defined by abnormal laxity in multiple joints in association with symptomatic joint pain. Previous studies in small populations suggest a predominance of female gender and nonwhite race among those diagnosed with hypermobility syndrome.

Carpal and Cubital Tunnel Syndrome: Who Gets Surgery?

Charles S. Day MD, MBA, Eric C. Makhni BS, Erika Mejia BA, Daniel E. Lage, Tamara D. Rozental MD

Despite the prevalence of carpal and cubital tunnel syndrome, and relief of symptoms following timely surgical release, it is unclear how nonclinical patient characteristics affect disease management.

Do Men Outperform Women During Orthopaedic Residency Training?

Katharine Pico MD, Terence J. Gioe MD, Ann VanHeest MD, Penny J. Tatman MPH

Orthopaedic surgery residency has one of the lowest percentages of women (13.1%) of all primary surgical specialties. There are many possible reasons for this, including bias during the selection process.

The Natural Progression of Shoulder Osteonecrosis Related to Corticosteroid Treatment

Philippe Hernigou MD, Charles-Henri Flouzat-Lachaniette MD, Xavier Roussignol MD, Alexandre Poignard MD

Little is known about the rate and factors of progression of shoulder osteonecrosis (ON) related to corticosteroids.

Hemiarthroplasty for Proximal Humerus Fractures in Patients with Parkinson’s Disease

Thomas J. Kryzak MD, John W. Sperling MD, MBA, Cathy D. Schleck BSc, Robert H. Cofield MD

Parkinson’s disease is a relatively common problem in geriatric patients with an annual incidence rate of 20.5 per 100,000. These patients are at increased risk for falls and resultant fractures. Several reports suggest total shoulder arthroplasty in patients with fractures has a relatively high rate of complications. Whether hemiarthroplasty reduces the rate of complications or improves pain or function is not known.

Vertebral Bodies or Discs: Which Contributes More to Human-like Lumbar Lordosis?

Ella Been PhD, Alon Barash MSc, Assaf Marom BSc, Patricia A. Kramer PhD

The attainment of upright posture, with its requisite lumbar lordosis, was a major turning point in human evolution. Nonhuman primates have small lordosis angles, whereas the human spine exhibits distinct lumbar lordosis (30°–80°). We assume the lumbar spine of the pronograde ancestors of modern humans was like those of extant nonhuman primates, but which spinal components changed in the transition from small lordosis angles to large ones is not fully understood.

Accuracy of Thoracic Pedicle Screw Using Ideal Pedicle Entry Point in Severe Scoliosis

Hitesh N. Modi MS, PhD, Seung-Woo Suh MD, PhD, Jae-Young Hong MD, Jae-Hyuk Yang MD

The ideal pedicle entry point for the thoracic spine is described as the base of the superior facet at the junction of the lateral and middle thirds of the pedicle. Investigators have reported its accuracy in curves less than 90°.

Does Ultrasound Correlate with Surgical or Histologic Findings in Greater Trochanteric Pain Syndrome? A Pilot Study

A. M. Fearon MPhysio, J. M. Scarvell PhD, J. L. Cook PhD, P. N. Smith FRACS

Greater trochanteric pain syndrome can be severely debilitating. Ideal imaging modalities are not established, treatments are not reliably evaluated, and the underlying pathology is not well understood.

Long-term Followup of Total Hip Arthroplasty in Patients with Cerebral Palsy

Bradley S. Raphael MD, Joshua S. Dines MD, Meredith Akerman MS, Leon Root MD

Patients with cerebral palsy (CP) are at risk for hip arthrosis secondary to the loss of joint congruity.

THA with the ABG I Prosthesis at 15 Years: Excellent Survival with Minimal Osteolysis

P. N. Baker MRCS, MSc, I. A. McMurtry FRCS, G. Chuter MRCS, A. Port FRCS, J. Anderson FRCS Following recent reports of poor results with the hydroxyapatite-coated ABG I prosthesis, we report the survival of a series of 63 patients (69 hips) at a mean of 15 years (range, 13–17 years). In total, eight patients had revision procedures. The reason for revision was acetabular loosening in all cases. In only one case was there associated clinical and radiographic loosening of the femoral stem. The 15-year survival of the acetabular component was 86.9% (95% confidence interval, 71.7%–96.0%) and the 15-year survival of the femoral component was 98.6% (95% confidence interval, 88.8%–100.0%). Periacetabular osteolysis was seen in 10 of 59 (17%) surviving hips. In these hips the components remained well fixed owing to the remaining bone-component contact. There was no difference in the Oxford hip score between patients with well-fixed hips and evidence of osteolysis and patients with hips without evidence of osteolysis. Multivariate analysis failed to reveal any factors associated with the presence of osteolysis (gender, age at primary surgery, Oxford hip score, cup abduction, and acetabular polyethylene wear rates). The ABG I prosthesis continues to show excellent long-term results. Ongoing radiographic review is recommended to detect progressive osteolysis that otherwise remains clinically silent until failure.,[object Object]

Leg Length and Offset Measures with a Pinless Femoral Reference Array during THA

Tobias Renkawitz MD, Tibor Schuster, Joachim Grifka MD, PhD, Thomas Kalteis MD, PhD, Ernst Sendtner MD The bony fixation of reference marker arrays used for computer-assisted navigation during total hip arthroplasty (THA) theoretically involves the risk of fracture, infection, and/or pin loosening. We asked whether intraoperative assessment of leg length (LL) and offset (OS) changes would be accurate using a novel pinless femoral reference system in conjunction with an imageless measurement algorithm based on specific realignment of the relationship between a dynamic femoral and pelvis reference array. LL/OS measurements were recorded during THA in 17 cadaver specimen hips. Preoperatively and postoperatively, specimens were scanned using CT. Linear radiographic LL/OS changes were determined by two investigators using visible fiducial landmarks and image processing software. We found a high correlation of repeated measurements within and between (both 0.95 or greater) the two examiners who did the CT assessments. Pinless LL/OS values showed mean differences less than 1 mm and correlations when compared with CT measurements.

The Impact of Prefracture and Hip Fracture Characteristics on Mortality in Older Persons in Brazil

Silvia R. M. Pereira MD, PhD, Martine T. E. Puts PhD, Margareth C. Portela PhD, Mario A. Sayeg MD, PhD

Hip fractures in the elderly are common and associated with considerable mortality and disability. Although well known in industrialized countries, the factors associated with mortality after hip fractures are not reported frequently in developing countries and little is known regarding risk factors in Latin America.

Cartilage Thickness in the Hip Measured by MRI and Stereology Before and After Periacetabular Osteotomy

Inger Mechlenburg MSc, PhD, Jens R. Nyengaard MD, DMSc, John Gelineck MD, Kjeld Soballe MD, DMSc, Anders Troelsen MD, PhD

Untreated hip dysplasia can result in a degenerative process joint and secondary osteoarthritis at an early age. While most periacetabular osteotomies (PAOs) are performed to relieve symptoms, the osteotomy is presumed to slow or prevent degeneration unless irreparable damage to the cartilage has already occurred.

How Active are Patients Undergoing Total Joint Arthroplasty?: A Systematic Review

Florian D. Naal MD, Franco M. Impellizzeri PhD

Qualitative research studies regarding physical activity in patients undergoing total joint arthroplasty (TJA) unfortunately are sparse in the current literature.

One Intraoperative Dose of Tranexamic Acid for Patients Having Primary Hip or Knee Arthroplasty

Fiona E. Ralley BSc, MBChB, FRCA, FRCSC, Donna Berta RN, Valerie Binns RN, James Howard MD, MSc, FRCSC, Douglas D. R. Naudie MD, FRCSC

Multiple studies suggest tranexamic acid reduces blood loss and red cell transfusions in patients undergoing THA or TKA. However, many of the dosing schedules in these studies are not ideally suited for routine application.

High Hip Center Technique Using a Biconical Threaded Zweymüller® Cup in Osteoarthritis Secondary to Congenital Hip Disease

Nikolaos A. Christodoulou MD, Konstantinos P. Dialetis MD, Athanasios N. Christodoulou MSc

The high hip center technique used for a deficient acetabulum is reconstruction of the hip at a high center of rotation. In the literature, there is no consensus regarding the value of this technique.

Femoral Head-neck Junction Deformity is Related to Osteoarthritis of the Hip

Hilton José Melo Barros MD, Gilberto Luis Camanho MD, PhD, Antônio Carlos Bernabé MD, PhD, Marcelo Bordalo Rodrigues MD, Luiz Eugênio Garcez Leme MD, PhD

Primary or idiopathic osteoarthritis (OA) of the hip has increasingly been attributed to the presence of presumably minor femoral or acetabular deformities that are not routinely identified. The alpha angle reflects one such deformity of the femoral neck and reflects a risk for femoroacetabular impingement, which in turn reportedly is associated with OA. If impingement is in fact associated with OA, then one might expect the mean alpha angle to be greater in patients with presumed idiopathic hip OA.

Medial Knee Osteoarthritis Treated by Insoles or Braces: A Randomized Trial

Tom M. Raaij MD, PhD, Max Reijman PhD, Reinoud W. Brouwer MD, PhD, Sita M. A. Bierma-Zeinstra PhD, Jan A. N. Verhaar MD, PhD

There is controversial evidence regarding whether foot orthoses or knee braces improve pain and function or correct malalignment in selected patients with osteoarthritis (OA) of the medial knee compartment. However, insoles are safe and less costly than knee bracing if they relieve pain or improve function.

One-stage Metatarsal Lengthening by Allograft Interposition: A Novel Approach for Congenital Brachymetatarsia

Sandro Giannini MD, Cesare Faldini MD, Stavroula Pagkrati MD, Maria Teresa Miscione MD, Deianira Luciani MD

Congenital brachymetatarsia, a shortened metatarsal bone, can be corrected surgically by callus distraction or one-stage lengthening using bone graft.

Percutaneous Radiofrequency Epiphysiodesis in a Rabbit Model: A Pilot Study

Roger F. Widmann MD, Terry D. Amaral MD, Cemil Yildiz MD, Xu Yang MD, Mathias Bostrom MD

Techniques for epiphysiodesis have evolved from open surgical techniques requiring direct observation of the physis to percutaneous techniques performed with fluoroscopy.

Femoral Shortening in Total Hip Arthroplasty for High Developmental Dysplasia of the Hip

Olav Reikerås MD, PhD, Jarl Erik Haaland MD, Paul Lereim MD, PhD

When reconstructing a hip with developmental dysplasia with a high dislocation, placing the acetabular component in the anatomic position can result in a prosthetic hip that is difficult to reduce. Subtrochanteric femoral osteotomy and shortening makes reduction easier but can be associated with complications (eg, limp, sciatic nerve injury, nonunion of the osteotomy) or compromise long-term stem survival.

No Recurrences in Selected Patients after Curettage with Cryotherapy for Grade I Chondrosarcomas

Badio S. Souna MD, Nicolas Belot MD, Hélène Duval MD, Frantz Langlais MD, Hervé Thomazeau MD

The low aggressiveness of Grade I chondrosarcomas is compatible with conservative surgical treatment.

Radiofrequency Ablation of Osteoid Osteoma in Atypical Locations: A Case Series

Shahram Akhlaghpoor MD, Alireza Aziz Ahari MD, Abbas Arjmand Shabestari MD, Mohammad Reza Alinaghizadeh MSc

Osteoid osteoma has a nidus surrounded by sclerotic bone with a size usually less than 20 mm. Its diagnosis is made on typical presentation of nocturnal pain and imaging findings. Excision of the niduses, which are often small and difficult to precisely identify, sometimes may result in resection of surrounding normal bone. Minimally invasive percutaneous treatments have been used to try to minimize resection of normal bone. Although minimally invasive radiofrequency ablation generally relieves pain, its ability to relieve pain is less well known in locations other than lower extremity long bones.

All-epiphyseal Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients

J. Todd R. Lawrence MD, PhD, Andrea L. Bowers MD, Jonathan Belding MD, Stephanie R. Cody BS, Theodore J. Ganley MD

Treating ACL injuries in prepubescent patients requires balancing the risk of chondral and meniscal injuries associated with delaying treatment against the risk of growth disturbance from early surgical reconstruction. Multiple physeal respecting techniques have been described to address this vulnerable population; however, none restore the native ACL attachments while keeping the graft and fixation entirely in the epiphysis.

Calcium Phosphate Cement with BMP-2-loaded Gelatin Microspheres Enhances Bone Healing in Osteoporosis: A Pilot Study

Meng Li MD, Xingyan Liu MD, Xudong Liu MD, Baofeng Ge MD

The capacity for bone healing reportedly is limited in osteoporosis with a less than ideal environment for healing of bone grafts. We therefore developed a composite bone substitute with rhBMP-2 loaded gelatin microsphere (GM) and calcium phosphate cement (CPC) to use in osteoporosis.

Case Report: Perioperative Use of Protein C Concentrate for Protein C Deficiency in THA

Savyasachi C. Thakkar BS, Michael B. Streiff MD, Duane F. Bruley PhD, PE, Simon C. Mears MD, PhD

Perioperative management of patients with heterozygous protein C deficiency is challenging because of the competing risks of bleeding and recurrent thrombosis.

Case Reports: Subtrochanteric Femoral Stress Fractures after Prolonged Alendronate Therapy

Katerina Cermak MD, Felix Shumelinsky MD, Jean Alexiou MD, Michael J. Gebhart MD

Alendronate is known for its ability to reduce bone loss in osteoporotic and osseous metastatic conditions. Its long-term effects remain unclear although several reports describe cases of proximal femur stress fractures associated with long-term alendronate use.

Knee Pain in a 17-year-old Girl

Skander Chaabane MD, Amira Merghani MD, Cyrine Drissi MD, Mohamed Fethi Ladeb PhD
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