Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 469 | Issue 6 | Jun, 2011

Biographical Sketch: Themistocles Gluck (1853–1942)

Richard A. Brand MD, Michael A. Mont MD, M. M. Manring PhD [object Object]

Survival of Hard-on-Hard Bearings in Total Hip Arthroplasty: A Systematic Review

Michael G. Zywiel MD, Siraj A. Sayeed MD, Aaron J. Johnson MD, Thomas P. Schmalzried MD, Michael A. Mont MD

Improvements in prosthetic materials, designs, and implant fixation for THA have led to bearing surface wear being the limitation of this technology. Hard-on-hard bearings promise decreased wear rates and increased survival. However, there may be different survival rates based on bearing materials, manufacturing technologies, and femoral component designs. Additionally, survival rate variability may be based on study design.

Do Large Heads Enhance Stability and Restore Native Anatomy in Primary Total Hip Arthroplasty?

Adolph V. Lombardi MD, FACS, Michael D. Skeels DO, Keith R. Berend MD, Joanne B. Adams BFA, Orlando J. Franchi MD

Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages.

Intraoperative Radiographs for Placing Acetabular Components in Hip Resurfacing Arthroplasty

Thomas P. Gross MD, Fei Liu PhD, Lee Webb NP

Various clinical and biomechanical studies suggest certain acetabular positions may be associated with higher wear and failure rates in modern metal-on-metal hip resurfacing arthroplasties. However, there are no widely available, reliable, and cost-effective surgical techniques that ensure surgeons are able to place an acetabular component within the safe range of inclination angles after hip resurfacing surgeries.

Does Acetabular Inclination Angle Affect Survivorship of Alumina-ceramic Articulations?

Henning R. Johansson MD, Aaron J. Johnson MD, Michael G. Zywiel MD, Marybeth Naughton BS, Michael A. Mont MD, Peter M. Bonutti MD

Reports in the literature have linked high acetabular inclination angles to increased wear of ceramic-on-ceramic bearings. However, many of these studies were only conducted in vitro and did not address the clinical relevance of such findings.

Is Resurfacing Arthroplasty Appropriate for Posttraumatic Osteoarthritis?

Aaron J. Johnson MD, Michael G. Zywiel MD, Uma I. Maduekwe MD, Fei Liu PhD, Michael A. Mont MD, Thomas P. Gross MD

High survival has been reported for resurfacing arthroplasty in patients with femoral deformities. Also, hardware removal may not always be necessary with resurfacing arthroplasty and may eliminate some of the difficulties performing total hip arthroplasty (THA) in patients with posttraumatic osteoarthritis.

Direct Anterior Approach for Hip Resurfacing: Surgical Technique and Complications

Stefan Kreuzer MD, Kevin Leffers BS, Suneel Kumar MD

The direct anterior approach (DAA) for hip resurfacing arthroplasty is a technically difficult approach but theoretically reduces the soft tissue trauma to the hip because it does not require muscle detachments from the bone. Furthermore, the patient is in the supine position facilitating fluoroscopy to control component placement. However, the complications associated with the learning curve and functional outcome scores are not well defined in the literature.

Hip Resurfacing in Patients Who Have Osteonecrosis and are 25 Years or Under

Siraj A. Sayeed MD, Aaron J. Johnson MD, D. Alex Stroh BS, Thomas P. Gross MD, Michael A. Mont MD

Young patients with osteonecrosis (ON) treated with THA often have suboptimal function and radiographic failure with eventual revision. Resurfacing may be an option because of potentially increased functionality and decreased radiographic failure, although neither has been confirmed in the literature.

Is Mid-head Resection a Durable Conservative Option in the Presence of Poor Femoral Bone Quality and Distorted Anatomy?

Derek J. W. McMinn MD, FRCS, Chandra Pradhan FRCS, MCh(Orth), Hena Ziaee BSc(Hons), Joseph Daniel FRCS, MS(Orth)

High medium-term survivorship of hip resurfacing arthroplasty in young patients has led to its increased usage. To achieve high survival rates, selecting patients with appropriate proximal femoral morphology and bone quality is important. For patients with poor bone quality or abnormal morphology, the mid-head resection technique is an alternative, bone-conserving procedure but whether this technique results in acceptable complications and survival is unknown.

A Squeaky Reputation: The Problem May Be Design-dependent

Javad Parvizi MD, FRCS, Bahar Adeli BA, Justin C. Wong MD, Camilo Restrepo MD, Richard H. Rothman MD, PhD

Squeaking is reportedly a complication in patients having ceramic-on-ceramic total hip implants. The etiology remains unknown and multifactorial with recent studies suggesting a relationship between the audible squeak and implant design. When we evaluated our ceramic-on-ceramic cohort, we noticed squeaking primarily in patients receiving an acetabular system designed with an elevated titanium rim.

Does a Plastic Drape Reduce Incidence of Heterotopic Ossification After Hip Resurfacing?

John S. Shields MD, Ali Mofidi MB, BAO, BCh, M Med Sci, FRCS(Orth), William G. Ward MD, Riyaz H. Jinnah MD, FRCS

High rates of heterotopic ossification have been associated with hip resurfacing as compared to THA. Bone debris from femoral head reamings is cited as one of the risk factors linked to increased rates of heterotopic ossification.

Aspirin Decreases Heterotopic Ossification After Hip Resurfacing

Ryan M. Nunley MD, Jinjun Zhu MD, PhD, John C. Clohisy MD, Robert L. Barrack MD

Heterotopic ossification (HO) is a concern for patients undergoing hip surgery, especially surface replacement arthroplasty (SRA) who tend to be younger, more active, and anticipate good motion. It is unclear, however, whether HO occurs more frequently after SRA than traditional total hip arthroplasty (THA) and whether aspirin influences the risk.

Avoiding Short-term Femoral Neck Fracture With Imageless Computer Navigation for Hip Resurfacing

Michael Olsen PhD, Emil H. Schemitsch MD, FRCS(C)

Femoral neck fracture in hip resurfacing has been attributed to technical error during femoral head preparation. In the absence of fracture, several radiographic findings have been speculated to increase the risk of femoral component failure.

Are There Benefits to One- versus Two-stage Procedures in Bilateral Hip Resurfacing?

Harlan C. Amstutz MD, Edwin P. Su MD, Michel J. Duff MA, Vincent A. Fowble MD

Short-term studies report comparable complication rates of one-stage bilateral versus two-stage procedures in hip resurfacing, although the long-term effects of such procedures on survivorship, quality of life, and disease-specific scores are currently unknown.

Surgical Variables Influence Metal Ion Levels After Hip Resurfacing

Nicholas M. Desy MD, Stephane G. Bergeron MD, Alain Petit PhD, Olga L. Huk MD, MSc, John Antoniou MD, PhD

Metal-on-metal bearings in surface arthroplasty are associated with prolonged periods of elevated ion circulation. However, there exists some controversy regarding the effect of different surgical variables on the concentration of metal ions in whole blood of patients after hip resurfacing.

Femoral Head Size Does Not Affect Ion Values in Metal-on-Metal Total Hips

Mitchell Bernstein MD, Alan Walsh MD, Alain Petit PhD, David J. Zukor MD, John Antoniou MD, PhD

Metal-on-metal articulations can release substantial amounts of particles containing cobalt and chromium into the surrounding milieu, causing concern for cellular toxicity and adverse local soft tissue reactions. The diameter of the femoral head has been one of the variables that inversely affects wear of metal-on-metal total hip arthroplasty (THA). The oxidative stress of increased metal ions can be measured with serum markers. It is still controversial if larger femoral head diameters decrease wear rates in patients with metal-on-metal THA and if the increased metal ions alter the body’s antioxidant status.

Early Markers of Nephrotoxicity in Patients With Metal-on-metal Hip Arthroplasty

Massimo Corradi MD, Joseph Daniel FRCS, Hena Ziaee BSc (Hons), Rossella Alinovi BSc, Antonio Mutti MD, Derek J. W. McMinn FRCS

Metal ions released from arthroplasty devices are largely cleared in urine, leading to high exposure in renal tissues. Validated early markers of renal damage are routinely used to monitor workers in heavy metal industries, and renal risk can be quantified in these industries. It is unclear if the ion levels in patients with metal-on-metal hips are sufficient to cause renal damage.

Functional Recovery Period after Arthroscopic Rotator Cuff Repair: Is it Predictable Before Surgery?

Tomoya Manaka MD, Yoichi Ito MD, Isshin Matsumoto MD, Kunio Takaoka MD, Hiroaki Nakamura MD

Several studies have reported functional recovery of the shoulder after arthroscopic rotator cuff repair (ARCR). Preoperative estimation of the time required for functional recovery is important for determining surgical indications and for planning timing of the surgery and an appropriate postoperative physical therapy.

Does Arthroscopic FAI Correction Improve Function with Radiographic Arthritis?

Christopher M. Larson MD, M. Russell Giveans PhD, Mehul Taylor MD

Previous studies reporting the impact of osteoarthritis (OA) on pain and function after hip arthroscopy largely predate resection of femoroacetabular impingement (FAI).

Preoperative Radiographic Assessment of Limb-length Discrepancy in Total Hip Arthroplasty

Geert Meermans MD, Ahmad Malik MRCS, Johan Witt FRCS, Fares Haddad FRCS

Pelvic radiographs are helpful in assessing limb-length discrepancy (LLD) before and after THA but are subject to variation. Different methods are used to determine LLDs. As a pelvic reference, both ischial tuberosities and the teardrops are used, and as a femoral reference, the lesser trochanter and center of the femoral head are used.

Pelvic Positioning Creates Error in CT Acetabular Measurements

Harold J. P. Bosse MD, Duron Lee MD, Eric R. Henderson MD, Debra A. Sala MS, PT, David S. Feldman MD

CT allows for accurate measurement of acetabular orientation and shape, but malpositioning of the pelvis may lead to measurement variance.

Micro-mobile Foot Compression Device Compared with Pneumatic Compression Device

Michael Dohm MD, Kim M. Williams MPH, Tim Novotny PhD

A combination mechanical-pharmacologic regimen is an accepted prophylactic treatment against symptomatic venous thromboembolism for patients undergoing total hip and knee arthroplasties. Foot pumps have been recognized as effective mechanical devices. Research suggests pharmacologic prophylaxis for venous thromboembolism is associated with complications and foot pumps offer an adjunct or alternative approach. Presumably the effectiveness of foot pumps relate to enhancement of venous flow.

Does Perception of Usefulness of Arthroscopic Simulators Differ with Levels of Experience?

Gabriëlle J. M. Tuijthof PhD, P. Visser MD, Inger N. Sierevelt MSc, C. Niek Dijk MD, PhD, Gino M. M. J. Kerkhoffs MD, PhD

Some commercial simulators are available for training basic arthroscopic skills. However, it is unclear if these simulators allow training for their intended purposes and whether the perception of usefulness relates to level of experience.

How to Treat A Tibial Post Fracture in Total Knee Arthroplasty?

Paul F. Lachiewicz MD

Posterior-stabilized TKAs, which use a polyethylene tibial post to articulate against a metal femoral cam, are used regularly. Reported complications are related to the patellofemoral articulation or the tibial post-cam mechanism. Fracture of the tibial post is an uncommon but disabling complication after posterior-stabilized TKA that requires operative treatment.

Is Minimally Invasive Total Knee Arthroplasty Associated with Lower Costs Than Traditional TKA?

Jason C. King MD, MPH, Paul A. Manner MD, Daniel L. Stamper PA-C, Douglas C. Schaad PhD, Seth S. Leopold MD

Studies of minimally invasive surgery (MIS) approaches to TKA have shown decreased postoperative pain, earlier return to function, and shorter lengths of stay in the hospital. However, it is unclear whether these differences translate into decreased costs or charges associated with care.

Is Total Ankle Arthroplasty A Cost-effective Alternative to Ankle Fusion?

Xan F. Courville MD, MS, Paul J. Hecht MD, Anna N. A. Tosteson ScD

Total ankle arthroplasty (TAA) implantation is increasing, as the potential for pain relief and restoration of function and risks are compared with those for ankle fusion. A previous analysis with a simple decision tree suggested TAA was cost-effective compared with ankle fusion. However, reevaluation is warranted with the availability of newer, more costly implants and longer-term patient followup data.

The Iliocapsularis Muscle: An Important Stabilizer in the Dysplastic Hip

D. Babst MD, S. D. Steppacher MD, R. Ganz MD, K. A. Siebenrock MD, M. Tannast MD

The iliocapsularis muscle is a little known muscle overlying the anterior hip capsule postulated to function as a stabilizer of dysplastic hips. Theoretically, this muscle would be hypertrophied in dysplastic hips and, conversely, atrophied in stable and well-constrained hips. However, these observations have not been confirmed and the true function of this muscle remains unknown.

Pelvic Deformity Influences Acetabular Version and Coverage in Hip Dysplasia

Masanori Fujii MD, Yasuharu Nakashima MD, Taishi Sato MD, Mio Akiyama MD, Yukihide Iwamoto MD

Although a wide variety of acetabular deformities in developmental dysplasia of the hip (DDH) have been reported, the morphologic features of the entire pelvis in DDH are not well characterized and their correlation with acetabular deformity is unknown.

Pelvic Rotation and Tilt Can Cause Misinterpretation of the Acetabular Index Measured on Radiographs

M. J. Bom PhD, M. E. Groote MD, K. L. Vincken PhD, F. J. Beek PhD, L. W. Bartels PhD

Radiographic diagnosis and followup studies of developmental dysplasia of the hip are commonly performed by measuring the acetabular index on radiographs using Hilgenreiner’s method. The outcome of the measurement, however, depends on the orientation of the subject’s pelvis relative to the xray source. The influence of pelvic rotation and tilt on the measurement error has been evaluated separately but not in combination.

Can the Toronto Extremity Salvage Score Produce Reliable Results When Used Online?

Mark Clayer MD, Aileen Davis PhD

Web-based questionnaires have become popular, however, access to the Internet can be biased regarding age, gender, and education, among other factors. Therefore, it is unknown whether this is a reasonable avenue to administer a questionnaire to patients or whether Web-based can be a reliable alternative to paper-based.

2010 Mid-America Orthopaedic Association Physician in Training Award: Healing Complications Are Common After Locked Plating for Distal Femur Fractures

Christopher E. Henderson MD, Trevor J. Lujan PhD, Lori L. Kuhl, Michael Bottlang PhD, Daniel C. Fitzpatrick MD, John L. Marsh MD

Several mechanical studies suggest locking plate constructs may inhibit callus necessary for healing of distal femur fractures. However, the rate of nonunion and factors associated with nonunion are not well established.

Distal Radius Osteotomy with Volar Locking Plates Based on Computer Simulation

Junichi Miyake MD, Tsuyoshi Murase MD, PhD, Hisao Moritomo MD, PhD, Kazuomi Sugamoto MD, PhD, Hideki Yoshikawa MD, PhD

Corrective osteotomy using dorsal plates and structural bone graft usually has been used for treating symptomatic distal radius malunions. However, the procedure is technically demanding and requires an extensive dorsal approach. Residual deformity is a relatively frequent complication of this technique.

Effects of a Knee Extension Constraint Brace on Lower Extremity Movements after ACL Reconstruction

Christopher J. Stanley MS, R. Alexander Creighton MD, Michael T. Gross PT, PhD, FAPTA, William E. Garrett MD, PhD, Bing Yu PhD

Patients have high reinjury rates after ACL reconstruction. Small knee flexion angles and large peak posterior ground reaction forces in landing tasks increase ACL loading.

The Accuracy of Digital Radiography in Orthopaedic Applications

John R. Fowler MD, Asif M. Ilyas MD

Recent advances in technology and the use of image archiving and communication systems (PACS) has led some institutions to abandon conventional plain film radiography and rely solely on digital computed radiography. The level of accuracy of digital radiography in measuring distances for orthopaedic applications is unclear.

Two Novel COL2A1 Mutations Associated with a Legg-Calvé-Perthes Disease-like Presentation

Peter Kannu MB, ChB, DCH, FRACP, Melita Irving MBBS, FRCP, Salim Aftimos MD, Ravi Savarirayan MBBS, FRACP

Abnormal development and growth of the capital femoral epiphysis and acetabulum are associated with a wide variety of underlying etiologies, one of which is Legg-Calvé-Perthes disease.

Emerging Ideas: Matrix Metalloproteinase-2 in Muscle Atrophy

Xuhui Liu MD

Muscle atrophy impacts almost every patient seen for orthopaedic conditions. Unfortunately, no effective treatment is available to date. Matrix metalloproteinases (MMPs), especially MMP-2, are involved in skeletal muscle atrophy. MMP-2 null mice reportedly have substantially reduced muscle atrophy after tendon transection compared with wild-type mice, suggesting MMP-2 plays an important role in muscle atrophy. Although the exact mechanisms remain unknown, a newly-discovered intracellular form of MMP-2 suggests a possible novel mechanism of MMP-2 digesting muscle matrix during muscle atrophy. I propose a new pharmacologic treatment for muscle atrophy using selective MMP-2 inhibitors.

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