Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 470 | Issue 11 | Nov, 2012

Surgical Technique: The Capsular Arthroplasty: A Useful But Abandoned Procedure for Young Patients With Developmental Dysplasia of the Hip

Reinhold Ganz MD, Theddy Slongo MD, Klaus A. Siebenrock MD, Luigino Turchetto MD, Michael Leunig MD

Codivilla in 1901, Hey Groves in 1926, and Colonna in 1932 described similar capsular arthroplasties—wrapping the capsule around the femoral head and reducing into the true acetabulum—to treat completely dislocated hips in children with dysplastic hips. However, these procedures were associated with relatively high rates of necrosis, joint stiffness, and subsequent revision procedures, and with the introduction of THA, the procedure vanished despite some hips with high functional scores over periods of up to 20 years. Dislocated or subluxated hips nonetheless continue to be seen in adolescents and young adults, and survival curves of THA decrease faster for young patients than for patients older than 60 years. Therefore, joint preservation with capsular arthroplasty may be preferable if function can be restored and complication rates reduced.

Intraarticular Abnormalities in Residual Perthes and Perthes-like Hip Deformities

James R. Ross MD, Jeffrey J. Nepple MD, Geneva Baca, Perry L. Schoenecker MD, John C. Clohisy MD

Residual Perthes and Perthes-like hip deformities are complex and may encompass proximal femoral deformity, secondary acetabular dysplasia, and associated intraarticular abnormalities. These intraarticular abnormalities have not been well characterized but may influence surgical technique and treatment outcomes.

What Factors Predict Failure 4 to 12 Years After Periacetabular Osteotomy?

Charlotte Hartig-Andreasen MD, Anders Troelsen MD, PhD, DMSc, Theis Muncholm Thillemann MD, PhD, Kjeld Søballe MD, DMSc

The goal of periacetabular osteotomy (PAO) is to delay or prevent osteoarthritic development in dysplastic hips. However, it is unclear whether the surgical goals are achieved and if so in which patients. This information is essential to select appropriate patients for a durable PAO that achieves its goals.

Does Standing Affect Acetabular Component Inclination and Version After THA?

Gregory G. Polkowski MD, Ryan M. Nunley MD, Erin L. Ruh MS, Brandon M. Williams DC, Robert L. Barrack MD

Avoiding complications after hip arthroplasty with hard-on-hard bearings, especially metal-on-metal, correlates with the position of the acetabular component. Supine imaging with conventional radiography has traditionally been utilized to assess component inclination (abduction), as well as anteversion, after THA and surface replacement arthroplasty (SRA). However, most adverse events with hard bearings (excessive wear and squeaking) have occurred with loading. Standing imaging, therefore, should provide more appropriate measurements.

Coordinating Retrieval and Register Studies Improves Postmarket Surveillance

Peter Ellison PhD, Geir Hallan MD, PhD, Paul Johan Høl PhD, Nils Roar Gjerdet DDS, PhD, Leif I. Havelin MD, PhD

The relative risk of revision of the Titanfemoral stem due to aseptic loosening increased after 2000; however, the reasons for this have not been established. A retrieval analysis was initiated with the aim of delineating the failure mechanism.

Do Joint Registries Report True Rates of Hip Dislocation?

Peter A. Devane MB, ChB, Philip J. Wraighte MB, ChB, David C. G. Ong MBBS, J. Geoffrey Horne MB, ChB

Despite advances in primary THA, dislocation remains a common complication. In New Zealand (NZ), dislocations are reported to the National Joint Registry (NJR) only when prosthetic components are revised in the treatment of a dislocation. Closed reductions of dislocated hips are not recorded by the NJR.

Head Material Influences Survival of a Cemented Total Hip Prosthesis in the Norwegian Arthroplasty Register

Thomas Kadar MD, Eva Dybvik MSc, Geir Hallan MD, PhD, Ove Furnes MD, PhD, Leif Ivar Havelin MD, PhD

High prosthesis survival is reported for total hip prostheses with metal and alumina heads, but direct comparisons of a single prosthesis design with one of two different head materials has seldom been studied. Prostheses with zirconia heads are less commonly used than metal and alumina heads, and the few reports suggest variable results with zirconia heads.

Cup Press Fit in Uncemented THA Depends on Sex, Acetabular Shape, and Surgical Technique

Eduardo García-Rey MD, PhD, Eduardo García-Cimbrelo MD, PhD, Ana Cruz-Pardos MD, PhD

Uncemented press-fit cups provide bone fixation in primary THA, but the use of screws is sometimes necessary to achieve primary stability of the socket. However, it is unclear whether and when screws should be used.

Femoral Bone Is Preserved Using Cemented Polished Stems in Young Patients

Donald W. Howie PhD, MBBS, FRACS, Kerry Costi BA, Margaret A. McGee BSc, MPH, Angela Standen RN, Lucian B. Solomon MD, PhD, FRACS

Techniques that ensure femoral bone preservation after primary THA are important in younger patients who are likely to undergo revision surgery.

High Survivorship of Cemented Sockets with Roof Graft for Severe Acetabular Dysplasia

Vincent J. J. F. Busch MD, Nicholas D. Clement MRCS, Ed, Philipp F. J. Mayer, Steffen J. Breusch FRCSEd, Colin R. Howie FRCSEd

Socket fixation in patients with acetabular dysplasia can be technically demanding but the use of structural grafts can help to reconstruct the original center of hip rotation. Because reported survival rates differ, construct survival seems to depend on the technique of graft preparation and fixation.

Tantalum Acetabular Cups Provide Secure Fixation in THA after Pelvic Irradiation at Minimum 5-year Followup

Siddharth B. Joglekar MD, Peter S. Rose MD, David G. Lewallen MD, Franklin H. Sim MD

Pelvic radiation has been commonly used to treat gastrointestinal, genitourinary, or hematopoietic malignancies. Conventional THA in these patients reportedly have high rates of fixation failure. Although secure short-term fixation reportedly occurs with trabecular metal implants following pelvic radiation, it is unclear whether the fixation is durable.

Is a Cementless Dual Mobility Socket in Primary THA a Reasonable Option?

Moussa Hamadouche MD, PhD, Hervé Arnould MD, Bertrand Bouxin MD

Dislocation after THA continues to be relatively common. Dual mobility sockets have been associated with low dislocation rates, but it remains unclear whether their use in primary THA would not introduce additional complications.

Does CT-Based Navigation Improve the Long-Term Survival in Ceramic-on-Ceramic THA?

Nobuhiko Sugano MD, PhD, Masaki Takao MD, PhD, Takashi Sakai MD, PhD, Takashi Nishii MD, PhD, Hidenobu Miki MD, PhD

Although navigated THA provides improved precision in implant positioning and alignment, it is unclear whether these translate into long-term implant survival.

Does Impact Sport Activity Influence Total Hip Arthroplasty Durability?

Matthieu Ollivier MD, Solenne Frey MD, Sebastien Parratte MD, PhD, Xavier Flecher MD, PhD, Jean-Noël Argenson MD

Return to sport is a key patient demand after hip arthroplasty and some patients are even involved in high-impact sports. Although polyethylene wear is related to the number of cycles and the importance of the load, it is unclear whether high-impact sport per se influences THA durability.

Does PFNA II Avoid Lateral Cortex Impingement for Unstable Peritrochanteric Fractures?

George A. Macheras MD, PhD, Stefanos D. Koutsostathis MD, PhD, Spyridon Galanakos MD, Konstantinos Kateros MD, PhD, Stamatios A. Papadakis MD, PhD

Proximal femoral nail antirotation devices (PFNAs) are considered biomechanically superior to dynamic hip screws for treating unstable peritrochanteric fractures and reportedly have a lower complication rate. The PFNA II was introduced to eliminate lateral cortex impingement encountered with the PFNA. However, it is unclear whether the new design in fact avoids lateral cortex impingement without compromising stability of fixation and fracture healing.

Edge Loading Has a Paradoxical Effect on Wear in Metal-on-Polyethylene Total Hip Arthroplasties

William H. Harris MD, DSc

Edge wear is an adverse factor that can negatively impact certain THAs. In some metal-on-metal THAs, it can lead to adverse tissue reactions including aseptic lymphocytic vasculitis-associated lesions and even to pseudotumor formation. In some ceramic-on-ceramic THAs, it can lead to squeaking and/or stripe wear. Edge wear in metal-on-metal and ceramic-on-ceramic THAs can also be associated with accelerated wear across the articulation of these joints.

Highly Crosslinked Polyethylene Does Not Reduce Aseptic Loosening in Cemented THA 10-year Findings of a Randomized Study

Per-Erik Johanson MD, Georgios Digas MD, PhD, Peter Herberts MD, PhD, Jonas Thanner MD, PhD, Johan Kärrholm MD, PhD

Polyethylene (PE) wear particles are believed to cause aseptic loosening and thereby impair function in hip arthroplasty. Highly crosslinked polyethylene (XLPE) has low short- and medium-term wear rates. However, the long-term wear characteristics are unknown and it is unclear whether reduced wear particle burden improves function and survival of cemented hip arthroplasty.

Alumina Heads Minimize Wear and Femoral Osteolysis Progression After Isolated Simple Acetabular Revision

Philippe Hernigou MD, Nicolas Dupuy MD, Olivier Pidet MD, Yashuhiro Homma MD, Charles Henri Flouzat Lachaniette MD

Patients with THA requiring cup revision for acetabular osteolysis may have a stable stem component without loosening. However, it is unclear whether isolated cup revision halts femoral osteolysis progression.

Corrosion at the Cone/Taper Interface Leads to Failure of Large-diameter Metal-on-metal Total Hip Arthroplasties

Heiko Meyer MD, Tina Mueller BS, Gesine Goldau BS, Kathrin Chamaon PhD, Marcel Ruetschi MD, Christoph H. Lohmann MD

Metal-on-metal (MoM) THAs have reduced wear rates compared with metal-on-polyethylene. However, elevated serum metal ion levels and pseudotumors have been reported in large MoM articulations.

Wear-Corrosion Synergism in a CoCrMo Hip Bearing Alloy Is Influenced by Proteins

Mathew T. Mathew MD, Joshua J. Jacobs MD, Markus A. Wimmer PhD

Although numerous in vitro studies report on the tribological performance of and, separately, on the corrosion properties of cobalt-based alloys in metal-on-metal (MoM) bearings, the few studies that take into account the synergistic interaction of wear and corrosion (tribocorrosion) have used canonical tribo-test methods. We therefore developed synergistic study using a test method that more closely simulates hip bearing conditions.

Do Survival Rate and Serum Ion Concentrations 10 Years After Metal-on-Metal Hip Resurfacing Provide Evidence for Continued Use?

Albrecht Hartmann MD, Jörg Lützner MD, Stephan Kirschner MD, Wolf-Christoph Witzleb MD, Klaus-Peter Günther MD

Owing to concerns attributable to problems associated with metal-on-metal bearing surfaces, current evidence for the use of hip resurfacing is unclear. Survival rates reported from registries and individual studies are controversial and the limited long-term studies do not conclusively allow one to judge whether hip resurfacing is still a reasonable alternative to conventional THA.

Socket Position Determines Hip Resurfacing 10-Year Survivorship

Harlan C. Amstutz MD, Michel J. Duff MA, Alicia J. Johnson BA

Modern metal-on-metal hip resurfacing arthroplasty designs have been used for over a decade. Risk factors for short-term failure include small component size, large femoral head defects, low body mass index, older age, high level of sporting activity, and component design, and it is established there is a surgeon learning curve. Owing to failures with early surgical techniques, we developed a second-generation technique to address those failures. However, it is unclear whether the techniques affected the long-term risk factors.

Do Revised Hip Resurfacing Arthroplasties Lead to Outcomes Comparable to Those of Primary and Revised Total Hip Arthroplasties?

William Desloges MD, Isabelle Catelas PhD, Toru Nishiwaki MD, Paul R. Kim MD, FRCSC, Paul E. Beaulé MD, FRCSC

A theoretical clinical advantage of hip resurfacing (HR) is the preservation of femoral bone. HR femoral component revision reportedly yields postoperative function comparable to that of primary THA. However, few studies have looked at the outcome of both HR femoral and acetabular side revisions.

Cementing Acetabular Liners Into Secure Cementless Shells for Polyethylene Wear Provides Durable Mid-term Fixation

John J. Callaghan MD, David W. Hennessy MD, Steve S. Liu MD, Kirsten E. Goetz, Anneliese D. Heiner PhD

In a previous experiment studying cementation of liners into cementless acetabular shells, placing grooves in the liner in a spider-web configuration created the greatest construct strength. Scoring shells without screw holes or other texturing helped prevent failure at the shell-cement interface. However, it was unclear whether these practices caused durable constructs in patients.

High Failure Rate with the GAP II Ring and Impacted Allograft Bone in Severe Acetabular Defects

Martin A. Buttaro MD, Diego Muñoz la Rosa MD, Fernando Comba MD, Francisco Piccaluga MD

Reconstruction rings and bone allografts have been proposed to manage severe acetabular bone loss. However, a high early failure rate of the Graft Augmentation Prosthesis (GAP) II reinforcement ring (Stryker Orthopaedics, Mahwah, NJ, USA) has been reported in one small series.

Acetabular Distraction: An Alternative for Severe Defects with Chronic Pelvic Discontinuity?

Scott M. Sporer MD, MS, John J. Bottros MD, Jonah B. Hulst MD, Vamsi K. Kancherla MD, Mario Moric MS, Wayne G. Paprosky MD

Stabilization of a pelvic discontinuity with a posterior column plate with or without an associated acetabular cage sometimes results in persistent micromotion across the discontinuity with late fatigue failure and component loosening. Acetabular distraction offers an alternative technique for reconstruction in cases of severe bone loss with an associated pelvic discontinuity.

Aggressive Early Débridement for Treatment of Acutely Infected Cemented Total Hip Arthroplasty

Mohamed Sukeik MRCSEd, Shelain Patel MRCS, Fares Sami Haddad FRCS(Tr&O)

Up to 2% of THAs are complicated by infection, leading to dissatisfied patients with poor function and major social and economic consequences. The challenges are control of infection, restoration of full function, and prevention of recurrence. Irrigation and débridement with or without exchange of modular components remains an attractive alternative to two-stage reimplantation in acutely infected THAs but with variable results from previous studies.

Clinical and Radiographic Factors Associated With Distal Radioulnar Joint Instability in Distal Radius Fractures

Bong Cheol Kwon MD, PhD, Bo Kyung Seo MD, Hyoung-June Im MD, Goo Hyun Baek MD, PhD

Distal radioulnar joint (DRUJ) instability is an important cause of ulnar-sided wrist pain in distal radius fractures. However, instability is frequently undiagnosed and the clinical and radiographic factors associated with instability are not well understood.

Correspondence of Patient Word Choice with Psychologic Factors in Patients With Upper Extremity Illness

Arjan G. J. Bot MD, Ana-Maria Vranceanu PhD, James H. Herndon MD, MBA, David C. Ring MD, PhD

Studies of patients with back pain, cancer, and in a general medical practice note that the use of certain phrases by a patient when communicating with their health provider can indicate greater disability and distress than expected for patients with a given disorder. However, it is unclear whether such phrases apply to patients with hand and arm disorders.

Precision and Accuracy Measurement of Radiostereometric Analysis Applied to Movement of the Sacroiliac Joint

Thomas J. Kibsgård MD, Olav Røise MD, PhD, Britt Stuge PT, PhD, Stephan M. Röhrl MD, PhD

Different techniques have been used to quantify the movement of sacroiliac (SI) joints. These include radiostereometric analysis (RSA), but the accuracy and precision of this method have not been properly evaluated and it is unclear how many markers are required and where they should be placed to achieve proper accuracy and precision.

Establishment of Parameters for Congenital Thoracic Stenosis: A Study of 700 Postmortem Specimens

Navkirat S. Bajwa BS, Jason O. Toy MD, Nicholas U. Ahn MD

Congenital thoracic stenosis (CTS) occurs when the bony anatomy of the canal is smaller than expected in the general population. The diagnosis currently is made based on the clinical impression from subjective radiographic studies, and the normal values for CTS have not been established.

L5 Pedicle Length Is Increased in Subjects With Spondylolysis: An Anatomic Study of 1072 Cadavers

Navkirat S. Bajwa BS, Jason O. Toy MD, Nicholas U. Ahn MD

In spondylolisthesis, it is believed that as L5 slips on S1, the pedicle may become elongated in response to the instability in an attempt to bridge the defect. Whether patients with spondylolysis, which is largely developmental, also develop elongation of the pedicles is unknown.

Does Bone Wax Induce a Chronic Inflammatory Articular Reaction?

Lucian B. Solomon MD, PhD, FRACS, Carlos Guevara MD, PD, Lorenz Büchler MD, Donald W. Howie MBBS, PhD, FRACS, Roger W. Byard MD, Martin Beck MD, PD

Bone wax is used to control femoral neck bleeding during open femoroacetabular impingement (FAI) surgery. Despite its widespread use, only a few case reports and small case series describe side effects after extraarticular use. It is unclear whether intraarticular use of bone wax leads to such complications. However, during revision FAI surgery, we have observed various degrees of articular inflammatory reactions.

Is the Infection Rate in Primary THA Increased After Steroid Injection?

Geert Meermans MD, Kristoff Corten MD, Jean-Pierre Simon MD, PhD

Injection of the hip is performed for diagnostic and therapeutic reasons. Articular cartilage deterioration and increased risk of prosthetic infection have been reported with steroid injections. However, the literature contains contradictory reports on an increased risk of infection after a subsequent THA.

Is Routine Mid-term Total Hip Arthroplasty Surveillance Beneficial?

James A. Keeney MD, Bradley S. Ellison MD, William J. Maloney MD, John C. Clohisy MD

Routine followup of patients after primary or revision THA is commonly practiced and driven by concerns that delays in identifying early failure will result in more complicated or more costly surgical interventions. Although mid-term followup (4–10 years) has been performed to follow cohorts of patients, the benefit of observing individual patients regardless of symptoms has not been established.

Is Femoral Component Rotation in a TKA Reliably Guided by the Functional Flexion Axis?

Sam Oussedik FRCS, Corey Scholes PhD, Duncan Ferguson FRCS, Justin Roe FRACS, David Parker FRACS

The position of the femoral component in a TKA in the axial plane influences patellar tracking and flexion gap symmetry. Errors in femoral component rotation have been implicated in the need for early revision surgery. Methods of guiding femoral component rotation at the time of implantation typically are derived from the mean position of the flexion-extension axis across experimental subjects. The functional flexion axis (FFA) of the knee is kinematically derived and therefore a patient-specific reference axis that can be determined intraoperatively by a computer navigation system as an alternative method of guiding femoral component rotation. However, it is unclear whether the FFA is reliable and how it compares with traditional methods.

Does Minimally Invasive Total Knee Arthroplasty Improve Isokinetic Torque?

Michael C. Liebensteiner MD, PhD, Martin Krismer MD, Arnold Koller PhD, Barbara Semenitz MD, Eckart Mayr MD

Less invasive dissection of the extensor apparatus, one of the aspects of minimally invasive surgical (MIS) TKA, might result in less reduction of postoperative quadriceps strength. However, it is unclear whether MIS is associated with less strength reduction.

Prereferral MRI Use in Patients with Musculoskeletal Tumors Is Not Excessive

Christopher T. Martin MD, Jose Morcuende MD, PhD, Joseph A. Buckwalter MS, MD, Benjamin J. Miller MD

Inappropriate MRI use has been targeted as a particular area of concern in orthopaedics, but it is unclear whether and to what extent its use is inappropriate in musculoskeletal oncology.

How Much Are Upper or Lower Extremity Disabilities Associated with General Health Status in the Elderly?

Young Hak Roh MD, Ki Woong Kim MD, Nam-Jong Paik MD, Tae Kyun Kim MD, Hyun Sik Gong MD

Musculoskeletal complaints influence general health status, but the relative contribution of concurrent upper and lower extremity disabilities on patient perceptions of general health is unclear.

Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Hari Om Gupta BS, MSIS, Sanjay Gupta MBBS, MRCS, MSc (Orth), MPhil, Robert Lewis Carter BSc, MBChB, FRCS, (T&O), Aslam Mohammed MD, FRCS, (T&O), R. M. Dominic Meek BSc, MD, FRCS, (T&O)

Elevated blood pressure (BP) is associated with increased cardiovascular risks manifested by ischemic heart disease and stroke. Studies of cardiothoracic surgeons and neurosurgeons suggest surgery induces a hemodynamic stress malresponse. However, it is unclear whether these occur in orthopaedic surgeons.

Erratum to: High Rate of Ceramic Sandwich Liner Fracture

Ronny Lopes MD, Jean M. Philippeau MD, Norbert Passuti MD, PhD, François Gouin MD, PhD

Orthopaedic Case of the Month: Pulsatile Soft Tissue Mass

Megan E. Anderson MD, Jeffrey D. Goldsmith MD, Mary G. Hochman MD, Amir Taghinia MD
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