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 9 | Sep, 2010

Do the Potential Benefits of Metal-on-Metal Hip Resurfacing Justify the Increased Cost and Risk of Complications?

Kevin J. Bozic MD, MBA, Christine M. Pui MD, Matthew J. Ludeman PhD, Thomas P. Vail MD, Marc D. Silverstein MD

Metal-on-metal hip resurfacing arthroplasty (MoM HRA) may offer potential advantages over total hip arthroplasty (THA) for certain patients with advanced osteoarthritis of the hip. However, the cost effectiveness of MoM HRA compared with THA is unclear.

Failed Metal-on-Metal Hip Arthroplasties: A Spectrum of Clinical Presentations and Operative Findings

James A. Browne MD, C. Dustin Bechtold MD, Daniel J. Berry MD, Arlen D. Hanssen MD, David G. Lewallen MD

A number of recent reports have described novel failure mechanisms of metal-on-metal bearings in total and resurfacing hip arthroplasty. Hip arthroplasties with metal-on-metal articulations are also subject to the traditional methods of failure seen with different bearing couples. There is currently little information in the literature to help guide timely clinical evaluation and management of these patients.

Histological Features of Pseudotumor-like Tissues From Metal-on-Metal Hips

Pat Campbell PhD, Edward Ebramzadeh PhD, Scott Nelson MD, Karren Takamura BA, Koen Smet MD, Harlan C. Amstutz MD

Pseudotumor-like periprosthetic tissue reactions around metal-on-metal (M-M) hip replacements can cause pain and lead to revision surgery. The cause of these reactions is not well understood but could be due to excessive wear, or metal hypersensitivity or an as-yet unknown cause. The tissue features may help distinguish reactions to high wear from those with suspected metal hypersensitivity.

Reduced Articular Surface of One-piece Cups: A Cause of Runaway Wear and Early Failure

William L. Griffin MD, Christopher J. Nanson MD, Bryan D. Springer MD, Matthew A. Davies PhD, Thomas K. Fehring MD

Despite the clinical success of modern metal-on-metal articulations, concerns with wear-related release of metal ions persist. Evidence suggests metal ion release is related to the effective coverage of the head in the metal shell (the cup’s functional articular arc). A recent study suggests a reduced functional articular arc is associated with increased ion release and the arc is a function of component design, size, and the abduction angle.

Squeaking in Metal-on-Metal Hip Resurfacing Arthroplasties

Christina Esposito BSc, William L. Walter MBBS, FRACS (Orth), PhD (Surg), Pat Campbell PhD, Anne Roques PhD

While most reports of audible squeaking in total hip arthroplasty (THA) have focused on ceramic bearings, squeaking can occur in metal-on-metal bearings and may be an important clinical complication to consider during patient followup.

Natural History of Squeaking after Total Hip Arthroplasty

Camilo Restrepo MD, Wadih Y. Matar MD, MSc, FRCSC, Javad Parvizi MD, FRCS, Richard H. Rothman MD, PhD, William J. Hozack MD

In recent years, a number of alternative bearing surfaces, such as ceramic on ceramic, are being used in THA. Squeaking after THA is a recently recognized complication; however, its incidence is unknown.

The Prevalence of Groin Pain After Metal-on-Metal Total Hip Arthroplasty and Total Hip Resurfacing

Robert B. Bartelt MD, Brandon J. Yuan MD, Robert T. Trousdale MD, Rafael J. Sierra MD

Groin pain after total hip arthroplasty (THA) or total hip resurfacing arthroplasty can be troubling for patients and surgeons. Potential sources of pain include infection, loosening, metal hypersensitivity, or impingement of bony structures or the iliopsoas tendon.

Risk of Complication and Revision Total Hip Arthroplasty Among Medicare Patients with Different Bearing Surfaces

Kevin J. Bozic MD, MBA, Kevin Ong PhD, Edmund Lau MS, Steven M. Kurtz PhD, Thomas P. Vail MD, Harry E. Rubash MD, Daniel J. Berry MD

To address the long-term problems of bearing surface wear and osteolysis associated with conventional metal-polyethylene (M-PE) total hip arthroplasty (THA), metal-metal (M-M), and ceramic-ceramic (C-C) bearings have been introduced. These bearing surfaces are associated with unique risks and benefits and higher costs. However the relative risks of these three bearings in an older population is unknown.

Factors That Predict Short-term Complication Rates After Total Hip Arthroplasty

Nelson F. SooHoo MD, Eugene Farng MD, Jay R. Lieberman MD, Lauchlan Chambers MD, David S. Zingmond MD, PhD

There remains uncertainty regarding the relative importance of patient factors such as comorbidity and provider factors such as hospital volume in predicting complication rates after total hip arthroplasty (THA).

Minimal Incision Surgery as a Risk Factor for Early Failure of Total Hip Arthroplasty

Bradley P. Graw MD, Steven T. Woolson MD, Heather G. Huddleston MD, Stuart B. Goodman MD, PhD, James I. Huddleston MD

Minimal incision total hip arthroplasty (MI THA) techniques were developed to decrease postoperative pain and recovery time. Although these techniques have increased in popularity, the long-term survivorship of these procedures is unknown.

Intraoperative Femur Fracture is Associated with Stem and Instrument Design in Primary Total Hip Arthroplasty

Keith R. Berend MD, Adolph V. Lombardi MD, FACS

Intraoperative proximal femoral fracture is a risk in total hip arthroplasty (THA) with cementless stems with reported rates of 1.5–27.8%. Certain designs or designs associated with certain types of instrumentation may have higher rates.

Early Experience with a Novel Nonmetallic Cable in Reconstructive Hip Surgery

Nicholas T. Ting BA, Glenn D. Wera MD, Brett R. Levine MD, Craig J. Della Valle MD

Metallic wires and cables are commonly used in primary and revision THA for fixation of periprosthetic fractures and osteotomies of the greater trochanter. These systems provide secure fixation and high healing rates but fraying, third-body generation, accelerated wear of the bearing surface, and injury to the surgical team remain concerning.

Should Gram Stains Have a Role in Diagnosing Hip Arthroplasty Infections?

Aaron J. Johnson MD, Michael G. Zywiel MD, D. Alex Stroh BS, David R. Marker BS, Michael A. Mont MD

The utility of Gram stains in diagnosing periprosthetic infections following total hip arthroplasty has recently been questioned. Several studies report low sensitivity of the test, and its poor ability to either confirm or rule out infection in patients undergoing revision total hip arthroplasty. Despite this, many institutions including that of the senior author continue to perform Gram stains during revision total hip arthroplasty.

Retrospective Analysis of Infection Rate After Early Reoperation in Total Hip Arthroplasty

Hussein Darwiche MD, Wael K. Barsoum MD, Alison Klika MS, Viktor E. Krebs MD, Robert Molloy MD

Infection is a devastating complication of total hip arthroplasty (THA). Unavoidable reoperation during the acute recovery phase of hip arthroplasty has the potential for an increased infection rate but the risk is not well established nor is the fate of these infected hips.

Incidence of Lateral Femoral Cutaneous Nerve Neuropraxia After Anterior Approach Hip Arthroplasty

Krista Goulding MD, Paul E. Beaulé MD, FRCSC, Paul R. Kim MD, FRCSC, Anna Fazekas MA

Although injury to the lateral femoral cutaneous nerve (LFCN) is a known complication of anterior approaches to the hip and pelvis, no study has quantified its’ incidence in anterior arthroplasty procedures.

Antiemesis After Total Joint Arthroplasty: Does a Single Preoperative Dose of Aprepitant Reduce Nausea and Vomiting?

Timothy M. DiIorio BS, Peter F. Sharkey MD, Agnes M. Hewitt MD, Javad Parvizi MD

Postoperative nausea and vomiting (PONV) is frequent after joint arthroplasty; in addition to causing patient distress, it interferes with early mobilization and hospital discharge. Various antiemetic agents reduce PONV, but their action is limited by a short half-life. Aprepitant, an antiemetic developed for patients receiving chemotherapy, has a duration of action much longer than other antiemetics.

Morphologic Evaluation of Chronic Radial Head Dislocation: Three-dimensional and Quantitative Analyses

Kunihiro Oka MD, Tsuyoshi Murase MD, Hisao Moritomo MD, Kazuomi Sugamoto MD, Hideki Yoshikawa MD

Treatment of chronic radial head dislocation is controversial, considering whether to reduce and reconstruct the proximal radioulnar joint. The anatomic alteration that influences the decision to reduce the dislocation is not completely understood.

Can Computer-assisted Surgery Reduce the Effective Dose for Spinal Fusion and Sacroiliac Screw Insertion?

Michael David Kraus MD, Gert Krischak PD Dr, Peter Keppler PD Dr, Florian T. Gebhard MD, Uwe H. W. Schuetz Dr med

The increasing use of fluoroscopy-based surgical procedures and the associated exposure to radiation raise questions regarding potential risks for patients and operating room personnel. Computer-assisted technologies can help to reduce the emission of radiation; the effect on the patient’s dose for the three-dimensional (3-D)-based technologies has not yet been evaluated.

Natural Course of Asymptomatic Deep Venous Thrombosis in Hip Surgery without Pharmacologic Thromboprophylaxis in an Asian Population

Kosuke Tsuda MD, Tomio Kawasaki MD, Nobuo Nakamura MD, Hideki Yoshikawa MD, Nobuhiko Sugano MD

The clinical importance of asymptomatic deep venous thrombosis in elective hip surgery is not clearly known.

Nonadherence in Outpatient Thrombosis Prophylaxis with Low Molecular Weight Heparins after Major Orthopaedic Surgery

Thomas Wilke PhD, Jörn Moock PhD, Sabrina Müller BSc, Matthias Pfannkuche PhD, Andreas Kurth PhD

According to some current guidelines, extended thromboprophylaxis after hip and knee arthroplasties is recommended. Outpatient prophylaxis with low molecular weight heparins (LMWH) is an important part of this prophylaxis, although the rates of adherence to these regimens is not known.

How Does Osteonecrosis About the Knee Progress in Young Patients with Leukemia?: A 2- to 7-year Study

E. J. Karimova MD, A. Wozniak MS, J. Wu PhD, M. D. Neel MD, S. C. Kaste DO

Osteonecrosis is a major treatment complication of pediatric leukemias owing to its potential to cause joint deterioration. Because of potential long-term effects of osteonecrosis on joints, information regarding its progression and collapse in different patients can be used to identify high-risk groups, advise the patients and parents of this complication, and potentially consider the risk for development of osteonecrosis in planning primary treatment.

Quadriceps and Hamstrings Muscle Dysfunction after Total Knee Arthroplasty

Jennifer E. Stevens-Lapsley PT, MPT, PhD, Jaclyn E. Balter MS, Wendy M. Kohrt PhD, Donald G. Eckhoff MD

Although TKA reliably reduces pain from knee osteoarthritis, full recovery of muscle strength and physical function to normal levels is rare. We presumed that a better understanding of acute changes in hamstrings and quadriceps muscle performance would allow us to enhance early rehabilitation after TKA and improve long-term function.

Routine Surveillance of Modular PFC TKA Shows Increasing Failures after 10 Years

Andrew S. Malin MD, John J. Callaghan MD, Kevin J. Bozic MD, MBA, Steve S. Liu MD, Devon D. Goetz MD, Nicholas Sullivan BS, Scott S. Kelley MD

A 10-year survivorship of 100% was reported for patients with PFC cruciate-retaining prostheses. Beyond 10 years, we observed additional polyethylene wear likely related to thin liners gamma-irradiated in air and were concerned this wear might predispose to implant construct failure.

Early Active Motion versus Immobilization after Tendon Transfer for Foot Drop Deformity: A Randomized Clinical Trial

Santosh Rath MS, Ton A. R. Schreuders PT, PhD, Henk J. Stam MD, PhD, Steven E. R. Hovius PhD, MD, Ruud W. Selles PhD

Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout.

Developmental Dysplasia of the Hip: Open Reduction as a Risk Factor for Substantial Osteonecrosis

G. B. Firth MBBCh, FCS (Orth) (SA), MMed (Orth) (Wits), A. J. F. Robertson MBBCh, MMed (Orth) (Wits), A. Schepers MBBCh, FRCS (Ed), L. Fatti PhD

Kalamchi and MacEwen (K&M) described a four-group scheme for classifying osteonecrosis (ON) following treatment for developmental dysplasia of the hip (DDH). However, the four groups can overlap in radiographic appearance, making assessment difficult.

The Role of Ultrasound in Clubfoot Treatment: Correlation with the Pirani Score and Assessment of the Ponseti Method

Khaled Loutfy El-Adwar Dr Ch Orth, Hesham Taha Kotb MD

To evaluate neonates and infants with clubfoot, clinical and imaging modalities are required. Conventional radiography is of limited value because the studied bones are not fully ossified.

Intercalary Allograft Reconstructions Using a Compressible Intramedullary Nail: A Preliminary Report

Benjamin J. Miller MD, Walter W. Virkus MD

Although intercalary allograft reconstructions are commonly performed using intramedullary devices, they cannot generate compression across host-allograft junctions. Therefore, they sometimes are associated with gap formation and suboptimal healing conditions.

Intramedullary Nailing as a ‘Second Hit’ Phenomenon in Experimental Research: Lessons Learned and Future Directions

Nikolaos G. Lasanianos MD, Nikolaos K. Kanakaris MD, PhD, Peter V. Giannoudis BSc, MB, FRCS

The ‘second hit’ phenomenon is based on the fundamental concept that sequential insults, which are individually innocuous, can lead to overwhelming physiologic reactions. This response can be expressed in several organic systems and can be examined by measurement of several parameters.

2010 Nicolas Andry Award: Multipotent Adult Stem Cells from Adipose Tissue for Musculoskeletal Tissue Engineering

Farshid Guilak, Bradley T. Estes, Brian O. Diekman, Franklin T. Moutos, Jeffrey M. Gimble

Cell-based therapies such as tissue engineering provide promising therapeutic possibilities to enhance the repair or regeneration of damaged or diseased tissues but are dependent on the availability and controlled manipulation of appropriate cell sources.

Case Report: Soft Tissue Metastasis from Immature Teratoma of the Testis: Second Case Report and Review of the Literature

Ahmet Bilici MD, Bala Basak Oven Ustaalioglu MD, Mesut Seker MD, Sibel Kayahan MD

Testicular cancer, like other histopathologic types, commonly metastasizes to the lungs, liver, and brain. Spread to soft tissue, however, is rare with only four cases with seminoma reported. However, one case with metastasis of testicular immature teratoma to soft tissue was documented previously.

Case Reports: Two Cases of Glenohumeral Chondrolysis after Intraarticular Pain Pumps

Okechukwu A. Anakwenze MD, Harish Hosalkar MD, MBMS(Orth), FCPS(Orth), DNB(Orth), G. Russell Huffman MD, MPH

Acute idiopathic chondrolysis in young adults is rare. The etiology often is unknown and outcomes can be devastating owing to rapid development of painful secondary osteoarthritis. There have been some recent reports of chondrolysis after arthroscopic shoulder procedures. Animal and laboratory data suggest chondrolysis is related to the use of intraarticular pain pumps, although there is no conclusive evidence that this is causative in patients.

Back to top