Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 471 | Issue 12 | Dec, 2013

Death, Taxes, and Trapeziometacarpal Arthrosis

Stéphanie J. E. Becker MD, Jan Paul Briet MD, Michiel G. J. S. Hageman MD, David Ring MD, PhD

Hand surgeons treat trapeziometacarpal arthrosis as if everyone with the disease presents for treatment despite evidence that suggests that trapeziometacarpal arthrosis is a normal part of human aging for which—it seems safe to assume—most people never seek medical attention.

Two or More Impingement and/or Instability Deformities Are Often Present in Patients With Hip Pain

Lisa M. Tibor MD, Gunnar Liebert MD, Reto Sutter MD, Franco M. Impellizzeri PhD, Michael Leunig MD

Damage to the hip can occur due to impingement or instability caused by anatomic factors such as femoral and acetabular version, neck-shaft angle, alpha angle, and lateral center-edge angle (CEA). The associations between these anatomic factors and how often they occur in a painful hip are unclear but if unaddressed might explain failed hip preservation surgery.

Valgus Hip With High Antetorsion Causes Pain Through Posterior Extraarticular FAI

Klaus A. Siebenrock MD, Simon Damian Steppacher MD, Pascal Cyrill Haefeli MD, Joseph Michael Schwab MD, Moritz Tannast MD

Valgus hips with increased antetorsion present with lack of external rotation and posterior hip pain that is aggravated with hip extension and external rotation. This may be the result of posterior femoroacetabular impingement (FAI).

Case Reports: Anteroinferior Acetabular Rim Damage Due to Femoroacetabular Impingement

Lisa M. Tibor MD, Reinhold Ganz MD, Michael Leunig MD

The most common location of labral tears and chondral damage in the hip is the anterosuperior region of the acetabulum, which is associated with pain in flexion and rotation. We describe a case series of patients with labral tears, ganglion formation, and chondromalacia isolated to the anteroinferior acetabulum. Clinically, patients had pain in extension and internal rotation.

Persistent Structural Disease Is the Most Common Cause of Repeat Hip Preservation Surgery

John C. Clohisy MD, Jeffrey J. Nepple MD, Christopher M. Larson MD, Ira Zaltz MD, Michael Millis MD

Hip preservation surgery has become more commonplace, yet when it fails, it is unclear why it does so. Understanding failed procedures should lead to improved surgical results.

Which Patients Are at Risk for Kidney Dysfunction After Hip Fracture Surgery?

George A. Macheras MD, PhD, Konstantinos Kateros MD, PhD, Stefanos D. Koutsostathis MD, PhD, Stamatios A. Papadakis MD, PhD, Eleftherios Tsiridis MD, PhD, FRCS

Kidney dysfunction (KD) after hip fracture surgery is a major complication. However, the incidence and risk factors of KD in this population are unclear.

Do Young, Active Patients Perceive Advantages After Surface Replacement Compared to Cementless Total Hip Arthroplasty?

Robert L. Barrack MD, Erin L. Ruh MS, Michael E. Berend MD, Craig J. Della Valle MD, C. Anderson Engh MD, Javad Parvizi MD, FRCS, John C. Clohisy MD, Ryan M. Nunley MD

Potential advantages suggested but not confirmed for surface replacement arthroplasty (SRA) over THA include lower frequency of limp, less thigh pain, less limb length discrepancy, and higher activity.

The Natural History of Inflammatory Pseudotumors in Asymptomatic Patients After Metal-on-metal Hip Arthroplasty

Sulaiman A. Almousa MBBS, Nelson V. Greidanus MD, MPH, Bassam A. Masri MD, Clive P. Duncan MD, MSc, Donald S. Garbuz MD, MHSc

Although pseudotumors have been reported in 32% of asymptomatic metal-on-metal hips, the natural history of asymptomatic pseudotumors is unknown.

Are Antibiotics Necessary in Hip Arthroplasty With Asymptomatic Bacteriuria? Seeding Risk With/Without Treatment

José Cordero-Ampuero MD, PhD, Enrique González-Fernández MD, David Martínez-Vélez MD, Jaime Esteban MD, PhD

In patients with asymptomatic bacteriuria undergoing hip arthroplasty, the risk of prosthetic joint infection (PJI) and appropriateness of specific antibiotics are unclear.

No Difference in Gait Recovery After THA With Different Head Diameters: A Prospective Randomized Study

Luigi Zagra MD, Federica Anasetti MSEng, Luca Bianchi MD, Vittorio Licari MD, Roberto Giacometti Ceroni MD

Larger femoral heads are commonly presumed to improve joint stability and hip biomechanics; some studies have suggested they may hasten recovery of a normal gait. To our knowledge, no gait analysis studies have compared different size head diameters in THA.

Femoral Remodeling Around Charnley Total Hip Arthroplasty Is Unpredictable

Matthew J. Teusink MD, Katharine A. Callaghan BA, Noelle F. Klocke MS, Devon D. Goetz MD, John J. Callaghan MD

There are two unusual remodeling patterns of the proximal femur around well-fixed Charnley total hip arthroplasties: cortical thinning leading to endosteal widening around the femoral component and hypertrophy of the distal femoral cortex. Previous studies have shown remodeling patterns are affected by stem design and occur early postoperatively. It is unclear if these changes are related to patient demographics or if they progress throughout the lifetime of the implant.

Is the Bone-bonding Ability of a Cementless Total Hip Prosthesis Enhanced by Alkaline and Heat Treatments?

Kazutaka So MD, PhD, Ayumi Kaneuji MD, PhD, Tadami Matsumoto MD, PhD, Shuichi Matsuda MD, PhD, Haruhiko Akiyama MD, PhD

Cementless total hip arthroplasty (THA) implants using alkaline and heat treatments were developed to enhance bone bonding. Although bone-bonding ability of the alkali- and heat-treated titanium surface has been demonstrated in animal studies, it remains unknown whether it enhances or provides durable bone bonding in humans.

Readmission Rates in the State of Florida: A Reflection of Quality?

Carlos J. Lavernia MD, Jesus M. Villa MD, David A. Iacobelli MD

High readmission rates are viewed by the Centers for Medicare & Medicaid Services as a quality of care determinant but it is unclear whether readmission rates per se reflect quality and the drivers of readmissions after hip arthroplasty remain unclear.

What Are the Causes for Failures of Primary Hip Arthroplasties in France?

Christian Delaunay MD, Moussa Hamadouche MD, PhD, Julien Girard MD, Alain Duhamel PhD

There are no large database cohorts describing the causes for failure of primary THAs in France. Because implants and causes for revision vary between national registers, it is important to obtain data from all countries.

Oxford Hip Scores at 6 Months and 5 Years Are Associated With Total Hip Revision Within the Subsequent 2 Years

Peter Devane MD, Geoffrey Horne MD, Daniel J. Gehling MD

The Oxford hip score (OHS) is commonly reported in research studies as a reflection of pain and function but it is unclear whether it predicts subsequent prosthesis failure.

Ceramic-on-ceramic Bearing Decreases the Cumulative Long-term Risk of Dislocation

Philippe Hernigou MD, Yasuhiro Homma MD, Olivier Pidet MD, Isaac Guissou MD, Jacques Hernigou MD

It is unclear whether late THA dislocations are related to mechanical impingement or to a biological mechanism that decreases the stability provided by the capsule (eg, inflammation secondary to osteolysis). It is also unknown if alumina-on-alumina bearing couples decrease the risk of late dislocation as a result of the absence of wear and osteolysis.

Acetabular Liner With Focal Constraint to Prevent Dislocation After THA

Jacob T. Munro MBChB, Mihai H. Vioreanu MD, MCh, Bassam A. Masri MD, Clive P. Duncan MD, MSc

Dislocation continues to commonly cause failure after primary and revision total hip arthroplasty (THA). Fully constrained liners intended to prevent dislocation are nonetheless associated with a substantial incidence of failure by redislocation, mechanical failure, aseptic loosening, or a combination. Constrained liners with cutouts of the elevated rims can theoretically increase range of movement and therefore decrease the risk dislocation, but it is unclear if they do so in practice and whether they are associated with early wear or loosening.

Low Rate of Dislocation of Dual-mobility Cups in Primary Total Hip Arthroplasty

Antoine Combes MD, Henri Migaud MD, Julien Girard MD, PhD, Alain Duhamel PhD, Michel Henri Fessy MD, PhD

Dual-mobility (DM) cups were introduced to minimize the risk of THA dislocation. The overall rate of dislocation of DM cups (including both large and small articulations) is controversial and ranges from 0% to 5% in previous studies.

What is the Long-term Survival of Impaction Allografting of the Femur?

Kevin L. Garvin MD, Beau S. Konigsberg MD, Natalie D. Ommen MPT, Elizabeth R. Lyden MS

Revision hip surgery of the femur for patients with substantial bone loss is challenging. We previously reported 41 patients (44 hips) treated with femoral impaction grafting followed for a minimum of 2 years. The survivorship, using femoral reoperation for symptomatic aseptic loosening as the end point, was 97% at 8 years. However, data on longer term survival are crucial to adequately compare this surgical technique with other types of revision hip arthroplasty procedures.

Increase of Cortical Bone After a Cementless Long Stem in Periprosthetic Fractures

Eduardo García-Rey MD, PhD, EBOT, Eduardo García-Cimbrelo MD, PhD, Ana Cruz-Pardos MD, PhD, Rosário Madero MS

Healing and functional recovery have been reported using an extensively porous-coated stem in Vancouver B2 and B3 periprosthetic fractures; however, loss of cortical bone has been observed when using these stems in revision surgery for aseptic loosening. However, it is unclear whether this bone loss influences subsequent loosening.

Method of Fixation Does Not Influence the Overall Risk of Rerevision in First-time Cup Revisions

Maziar Mohaddes MD, Göran Garellick MD, PhD, Johan Kärrholm MD, PhD

During the last two decades, uncemented fixation has been increasingly preferred worldwide during cup revision surgery. In Sweden, the number of uncemented cup revisions has been increasing during the last decade. However, it is unclear whether the risk of rerevision differs between cemented and uncemented cups.

Debate: Gun Control in the United States

Michael Boylan PhD, Don B. Kates JD, Ronald W. Lindsey MD, Zbigniew Gugala MD, PhD

Antibiotics in the Treatment of Low-velocity Gunshot-induced Fractures: A Systematic Literature Review

Efthymios Papasoulis MD, Michael J. Patzakis MD, Charalampos G. Zalavras MD, PhD

Low-velocity gunshots are often associated with extremity fractures. There is no consensus, however, on the use of antibiotics for these injuries.

Civilian Gunshot Injuries of the Spinal Cord: A Systematic Review of the Current Literature

Gursukhman S. Sidhu MBBS, Arvindera Ghag MD, Vanessa Prokuski BA, Alexander R. Vaccaro PhD, Kristen E. Radcliff MD

The principles that guide management of spinal cord injury (SCI) derive from injury resulting from blunt trauma, not gunshot wounds. Civilian gunshot-induced spinal cord injury (CGSWSCI) is a common, potentially serious cause of neurological deficit; there is disagreement about whether the same approaches used for SCI caused by blunt-force trauma should apply to gunshot-induced SCI.

Retained Bullet Removal in Civilian Pelvis and Extremity Gunshot Injuries: A Systematic Review

John T. Riehl MD, Adam Sassoon MD, Keith Connolly BS, George J. Haidukewych MD, Kenneth J. Koval MD

Although gunshot injuries are relatively common, there is little consensus about whether retained bullets or bullet fragments should be removed routinely or only in selected circumstances.

The Initial Trauma Center Fluid Management of Penetrating Injury: A Systematic Review

Nicole M. Tapia MD, James Suliburk MD, Kenneth L. Mattox MD

Damage-control resuscitation is the prevailing trauma resuscitation technique that emphasizes early and aggressive transfusion with balanced ratios of red blood cells (RBCs), plasma (FFP), and platelets (Plt) while minimizing crystalloid resuscitation, which is a departure from Advanced Trauma Life Support (ATLS) guidelines. It is unclear whether the newer approach is superior to the approach recommended by ATLS.

Retrograde Versus Antegrade Intramedullary Nailing of Gunshot Diaphyseal Femur Fractures

Paul J. Dougherty MD, Petra Gherebeh MD, Mark Zekaj BS, Sajiv Sethi BS, Bryant Oliphant MD, Rahul Vaidya MD

The use of retrograde nailing for gunshot wound femur fractures is controversial due to concerns of knee sepsis after this procedure since the knee is entered to introduce the nail into the canal.

Statistical Validity and Clinical Merits of a New Civilian Gunshot Injury Classification

Socrates A. Brito MD, Zbigniew Gugala MD, PhD, Alai Tan MD, PhD, Ronald W. Lindsey MD

Despite the high prevalence of civilian gunshot injuries (GSIs) in the United States, no universally accepted classification currently exists. Recently, two of us (ZG, RWL) proposed a GSI classification based on energy transferred, vital structure damage, wound characteristics, fracture, and degree of contamination. This classification has not been validated in a clinical setting.

Is TKA Using Patient-specific Instruments Comparable to Conventional TKA? A Randomized Controlled Study of One System

Yoon Whan Roh MD, Tae Woo Kim MD, Sahnghoon Lee MD, PhD, Sang Cheol Seong MD, PhD, Myung Chul Lee MD, PhD

Patient-specific CT-based instrumentation may reduce implant malpositioning and improve alignment in TKA. However, it is not known whether this innovation is an advance that benefits patients.

The Value of Valgus Stress Radiographs in the Workup for Medial Unicompartmental Arthritis

Wenzel Waldstein MD, Jad Bou Monsef MD, Johannes Buckup MD, Friedrich Boettner MD

High tibial osteotomy and unicompartmental knee arthroplasty are surgical treatment options for unicompartmental knee arthritis; these procedures are indicated for patients who do not have severe arthritis in the lateral compartment. Valgus stress radiographs sometimes are used to make this evaluation, but this test has not been critically evaluated.

Correlation of Magnetic Resonance Arthrography with Revision Hip Arthroscopy

Joseph C. McCarthy MD, Philip J. Glassner MD

Arthroscopic approaches for the diagnosis and treatment of hip disorders are well established; however, there are limited data regarding revision hip arthroscopy. There have been several studies evaluating the findings of MR arthrography with primary hip arthroscopy, but to our knowledge, no study has evaluated the diagnostic value of MR arthrography before revision hip arthroscopy.

Unplanned Hip Arthroplasty Imposes Clinical and Cost Burdens on Treating Institutions

Atul F. Kamath MD, Daniel C. Austin BA, Peter B. Derman MD, MBA, Craig L. Israelite MD

Emergent surgery has been shown to be a risk factor for perioperative complications. Studies suggest that patient morbidity is greater with an unplanned hip arthroplasty, although it is controversial whether unplanned procedures also result in higher patient mortality. The financial impact of these procedures is not fully understood, as the costs of unplanned primary hip arthroplasties have not been studied previously.

Validation of the Brazilian Version of the Musculoskeletal Tumor Society Rating Scale for Lower Extremity Bone Sarcoma

Daniel Cesar Seguel Rebolledo MD, João Ricardo Nickenig Vissoci MD, Ricardo Pietrobon MD, PhD, Olavo Pires Camargo MD, PhD, Andre Mathias Baptista MD, PhD

The Musculoskeletal Tumor Society (MSTS) rating scale is an English-language instrument used worldwide to assess functional evaluation of patients with musculoskeletal cancer. Despite its use in several studies in English-speaking countries, its validity for assessing patients in other languages is unknown. The translation and validation of widely used scales can facilitate the comparison across international patient samples.

Cerebral Desaturation During Shoulder Arthroscopy: A Prospective Observational Study

Dane Salazar MD, Benjamin W. Sears MD, John Andre BS, Pietro Tonino MD, Guido Marra MD

Patients undergoing arthroscopic shoulder surgery in the beach chair position may be at increased risk for serious neurocognitive complications as a result of cerebral ischemia.

Abbreviated Psychologic Questionnaires Are Valid in Patients With Hand Conditions

Arjan G. J. Bot MD, Stéphanie J. E. Becker MD, C. Niek Dijk MD, PhD, David Ring MD, PhD, Ana-Maria Vranceanu PhD

The Pain Catastrophizing Scale (PCS) and Short Health Anxiety Inventory (SHAI) can help hand surgeons identify opportunities for psychologic support, but they are time consuming. If easier-to-use tools were available and valid, they might be widely adopted.

Tracked Ultrasound Snapshots in Percutaneous Pedicle Screw Placement Navigation: A Feasibility Study

Tamas Ungi MD, PhD, Eric Moult BSc, Joseph H. Schwab MD, Gabor Fichtinger PhD

Computerized navigation improves the accuracy of minimally invasive pedicle screw placement during spine surgery. Such navigation, however, exposes both the patient and the staff to radiation during surgery. To avoid intraoperative exposure to radiation, tracked ultrasound snapshots—ultrasound image frames coupled with corresponding spatial positions—could be used to map preoperatively defined screw plans into the intraoperative coordinate frame. The feasibility of such an approach, however, has not yet been investigated.

Surgical Dislocation Technique for the Treatment of Acetabular Fractures

Alessandro Masse MD, Alessandro Aprato MD, Luca Rollero MD, Andrea Bersano MD, Reinhold Ganz MD

Surgical hip dislocation allows for a 360° view of the acetabulum and may facilitate a reduction in selected acetabular fractures. To our knowledge there is no description in the literature of the different techniques used to reduce acetabular fractures through this approach. The aims of this study are to describe a technique of hip surgical dislocation to treat a variety of acetabular fracture patterns and to ascertain the early results with this technique, including the quality of fracture reductions achieved, clinical results, operative time, and complications such as avascular necrosis and heterotopic ossification.

International Consensus on Periprosthetic Joint Infection: Description of the Consensus Process

William Cats-Baril PhD, Thorsten Gehrke MD, Katherine Huff BA, Daniel Kendoff MD, Mitchell Maltenfort PhD, Javad Parvizi MD, FRCS

Postoperative Opioid Administration Inhibits Bone Healing in an Animal Model

Jesse Chrastil MD, Christopher Sampson BS, Kevin B. Jones MD, Thomas F. Higgins MD

The current mainstay of orthopaedic pain control is opioid analgesics but there are few studies in the literature evaluating the effects of opioids on bone healing.

Adverse Local Tissue Reaction Associated With a Modular Hip Hemiarthroplasty

Michael R. Whitehouse PhD, MSc, FRCS (Tr & Orth), Makoto Endo MD, PhD, Bassam A. Masri MD, FRCS(C)

The local and systemic effects of wear debris and corrosion products remain a concern in arthroplasty and reaction to corrosion or wear products from modular junctions has been reported in primary and revision total joint arthroplasties. These effects have not been reported previously for unipolar hemiarthroplasties where there is no prosthetic bearing surface to contribute to the phenomenon. This may have implications for clinical surveillance and implant design.

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