Do the Potential Benefits of Metal-on-Metal Hip Resurfacing Justify the Increased Cost and Risk of Complications?
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
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.
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.
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.
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.
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.
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
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.
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 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
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.
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.
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.
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.
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?
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
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?
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
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
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
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.
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.
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
Immobilization after tendon transfers has been the conventional postoperative management. Several recent studies suggest early mobilization does not increase tendon pullout.
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
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
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
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
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
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.
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.