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 2 | Feb, 2013

Emerging Ideas: Novel 3-D Quantification and Classification of Cam Lesions in Patients With Femoroacetabular Impingement

Richard W. Kang MD, Adam B. Yanke MD, Alejandro Espinoza Orias PhD, Nozomu Inoue PhD, Shane J. Nho MD

Femoroacetabular impingement (FAI) can lead to labral injury, osseous changes, and even osteoarthritis. The literature contains inconsistent definitions of the alpha angle and other nonthree-dimensional (3-D) radiographic measures. We present a novel approach to quantifying cam lesions in 3-D terms. Our method also can be used to develop a classification system that describes the exact location and size of cam lesions.

The 2012 Otto Aufranc Award: The Interpretation of Metal Ion Levels in Unilateral and Bilateral Hip Resurfacing

Catherine Straeten MD, George Grammatopoulos MD, Harinderjit S. Gill BEng, DPhil, Alessandro Calistri MD, Patricia Campbell PhD, Koen A. Smet MD

The interpretation of metal ion concentrations and their role in clinical management of patients with metal-on-metal implants is still controversial.

The 2012 Frank Stinchfield Award: Decreasing Patient Activity With Aging: Implications for Crosslinked Polyethylene Wear

Andrew K. Battenberg BS, Jeffrey S. Hopkins MD, Andrew D. Kupiec, Thomas P. Schmalzried MD

Patient activity influences polyethylene wear. However, it is unclear how individual activity changes with patient aging after THA.

The 2012 John Charnley Award: Clinical Multicenter Studies of the Wear Performance of Highly Crosslinked Remelted Polyethylene in THA

Charles R. Bragdon PhD, Michael Doerner BS, John Martell MD, Bryan Jarrett BS, Henrik Palm MD, Henrik Malchau MD, PhD

Highly crosslinked polyethylene (HXLPE) in THA was developed to reduce particle-induced periprosthetic osteolysis. A series of clinical studies were initiated to determine the clinical efficacy as judged by patient-reported scores, radiographic osteolysis, and wear analysis of one form of HXLPE.

Acetabular Cup Design Influences Deformational Response in Total Hip Arthroplasty

John B. Meding MD, Scott R. Small MS, Mary E. Jones, Michael E. Berend MD, Merrill A. Ritter MD

Press-fit acetabular components are susceptible to deformation in an underreamed socket, with excessive deformation of metal-on-metal (MOM) components potentially leading to increased torsional friction and micromotion. Specifically, however, it remains unclear how cup diameter, design, and time from implantation affect shell deformation.

Risk Factors for Dislocation After Revision Total Hip Arthroplasty

Nathan G. Wetters BS, Trevor G. Murray MD, Mario Moric MS, Scott M. Sporer MD, Wayne G. Paprosky MD, Craig J. Della Valle MD

Despite dislocation being the most frequent complication after revision THA, risk factors for its occurrence are not completely understood.

Pelvic Tilt Is Minimally Changed by Total Hip Arthroplasty

William S. Murphy, Greg Klingenstein MD, Stephen B. Murphy MD, Guoyan Zheng PhD

While surgical navigation offers the opportunity to accurately place an acetabular component, questions remain as to the best goal for acetabular component positioning in individual patients. Overall functional orientation of the pelvis after surgery is one of the most important variables for the surgeon to consider when determining the proper goal for acetabular component orientation.

Should We Worry About Periacetabular Interference Gaps in Hip Resurfacing?

Bruno Gomes MBBS, FRACS(Orth), Michael Olsen PhD, Michael Donnelly MD, MCh, FRCS(Tr&Orth), Ashesh Kumar MD, FRCS(C), Emil H. Schemitsch MD, FRCS(C)

Press-fit acetabular component seating in hip resurfacing can be challenging as a strong interference fit is required. It has not been established whether reducing the acetabular underream minimizes incomplete component seating or leads to increased acetabular loosening.

The Withdrawn ASR™ THA and Hip Resurfacing Systems: How Have Our Patients Fared Over 1 to 6 Years?

Kevin T. Hug MD, Tyler S. Watters MD, Thomas P. Vail MD, Michael P. Bolognesi MD

The Articular Surface Replacement™ (ASR™) metal-on-metal hip arthroplasty system (DePuy Orthopaedics, Inc, Warsaw, IN, USA) reportedly has a higher than anticipated early failure rate leading to a voluntary recall. This prompted us to evaluate all ASR™ components implanted at our center.

Low Early and Late Dislocation Rates with 36- and 40-mm Heads in Patients at High Risk for Dislocation

Paul F. Lachiewicz MD, Elizabeth S. Soileau BSN

Large (36- and 40-mm) femoral heads with highly crosslinked polyethylene liners were introduced to reduce the risk of dislocation after primary total hip arthroplasty (THA), but it is unclear whether the risk is reduced and whether there is osteolysis or liner fracture.

Patients Report Improvement in Quality of Life and Satisfaction After Hip Resurfacing Arthroplasty

Wael A. Rahman MD, Nelson V. Greidanus MD, MPH, Alexander Siegmeth MD, Bassam A. Masri MD, Clive P. Duncan MD, MSc, Donald S. Garbuz MD, MHSc

A number of reconstructive procedures are available for the management of hip osteoarthritis. Hip resurfacing arthroplasty is now an accepted procedure, with implant survivorship comparable to THA at up to 10 years’ followup in certain series. Most reports focus on implant survivorship, surgeon-derived results, or complications. Fewer data pertain to patient-reported results, including validated measures of quality of life (QoL) and satisfaction and baseline measures from which to determine magnitude of improvement. Validated patient-reported results are essential to guide patients and surgeons in the current era of informed and shared decision making.

High Survival of Modular Tapered Stems for Proximal Femoral Bone Defects at 5 to 10 Years Followup

Andrew P. Houwelingen MD, Clive P. Duncan MD, MSc, Bassam A. Masri MD, Nelson V. Greidanus MD, MPH, Donald S. Garbuz MD, MHSc

Currently, the two most commonly used options for the revision of femoral components in North America are: cylindrical, nonmodular, cobalt-chromium stems and tapered, fluted, modular, titanium (TFMT) stems. Previous reports have cited high failure rates with cylindrical cobalt chrome stems in large femoral defects but the longer term survival of the fluted stems is unknown.

Outcomes of Minimally Invasive Anterolateral THA Are Not Superior to Those of Minimally Invasive Direct Lateral and Posterolateral THA

Nelson V. Greidanus MD, MPH, Samir Chihab MD, Donald S. Garbuz MD, MHSc, Bassam A. Masri MD, Michael Tanzer MD, Allan E. Gross MD, Clive P. Duncan MD, MSc

There has been considerable interest in minimally invasive surgical (MIS) THA in recent years. The MIS anterolateral approach, or the MIS Watson-Jones approach, is a novel intermuscular abductor-sparing technique. Early reports from case series suggest the potential for superior function and reduced complications; however, the available information from clinical reports is inadequate to suggest surgeons should change from their accepted standard approach.

Disclosure of Financial Conflicts of Interest: An Evaluation of Orthopaedic Surgery Patients’ Understanding

Jay R. Lieberman MD, Michael J. Pensak MD, Michael S. Kelleher MD, Robin R. Leger PhD, Gregory G. Polkowski MD

Industry and orthopaedic surgeons often partner to develop new technology, which can lead to orthopaedic surgeons having financial conflicts of interest (FCOI). It is essential these FCOI be conveyed clearly to patients. It is unclear, however, whether and to what degree patients understand the ramifications of physician FCOI.

The Shape of the Proximal Femur Influences Acetabular Wear Patterns Over Time

Jonathan J. Streit MD, Ari Levine MD, Ian J. Barrett BS, Daniel R. Cooperman MD, Victor Goldberg MD

Femoroacetabular impingement has been proposed as a cause of early osteoarthritis, but it is not known how this develops over time or whether the shape of the proximal femur influences this risk.

Smoking May Be a Harbinger of Early Failure With Ultraporous Metal Acetabular Reconstruction

Adolph V. Lombardi MD, Keith R. Berend MD, Joanne B. Adams BFA, Ryan C. Jefferson BS, Michael A. Sneller BS

Smoking is considered a risk factor for surgical complications in total hip arthroplasty (THA) and has been linked to a higher rate of aseptic loosening in uncemented acetabular components. Acetabular reconstruction with newer ultraporous metals in both complex primary and revision THA has increased survivorship but it is unclear whether smoking affects survival of these implants.

Prevalence and Treatment of Intraarticular Pathology Recognized at the Time of Periacetabular Osteotomy for the Dysplastic Hip

John G. Ginnetti MD, Christopher E. Pelt MD, Jill A. Erickson PA-C, Christin Dine PA-C, Christopher L. Peters MD

The indication for hip arthrotomy accompanied by intraarticular work during periacetabular osteotomy (PAO) has not been precisely defined. To validate a role for routine hip arthrotomy accompanied by intraarticular work, frequent intraarticular pathology must exist, and the adjunct procedures must not be associated with inferior relief of pain, reduced function, radiographic osteoarthritis progression, or conversion to THA.

Alcohol Use in Elective Total Hip Arthroplasty: Risk or Benefit?

Carlos J. Lavernia MD, Jesus M. Villa MD, Juan S. Contreras MD

Excessive alcohol consumption has been associated with adverse health measures after elective surgery. The effects of low or moderate consumption remain unclear.

Two-stage Treatment of Hip Periprosthetic Joint Infection Is Associated With a High Rate of Infection Control but High Mortality

Keith R. Berend MD, Adolph V. Lombardi MD, Michael J. Morris MD, Adam G. Bergeson MD, Joanne B. Adams BFA, Michael A. Sneller BS

Periprosthetic infection after total hip arthroplasty (THA) is a devastating complication. Reported rates of infection control range from 80% to 95% but mortality rates associated with treatment of infected THA are also substantial and we suspect underreported.

What Factors Affect Posterior Dislocation Distance in THA?

Jim Nevelos PhD, Aaron Johnson MD, Christopher Heffernan, James Macintyre, David C. Markel MD, Michael A. Mont MD

Dislocation remains common after total hip arthroplasty. Efforts have been made to identify and minimize risk factors. One such factor, jump distance, or the distance the femoral head must travel before dislocating, has been poorly characterized with respect to three-dimensional kinematics.

Do Obesity and/or Stripe Wear Increase Ceramic Liner Fracture Risk? An XFEM Analysis

Jacob M. Elkins MS, Douglas R. Pedersen PhD, John J. Callaghan MD, Thomas D. Brown PhD

Hypothesized risk factors for fracture of ceramic liners include impingement, edge-loading, and cup malpositioning. These risk factors are similar to those for generation of stripe wear. However, it is unclear whether the biomechanical conditions contributing to stripe wear generation also increase the risk for ceramic liner fracture

Lessons Learned From Managing a Prospective, Private Practice Joint Replacement Registry: A 25-year Experience

Joshua T. Carothers MD, Richard E. White MD, Krishna R. Tripuraneni MD, Mohammad W. Hattab MS, Michael J. Archibeck MD

In 1984, we developed a private practice joint replacement registry (JRR) to prospectively follow patients undergoing THA and TKA to assess clinical and radiographic outcomes, complications, and implant survival. Little has been reported in the literature regarding management of this type of database, and it is unclear whether and how the information can be useful for addressing longer-term questions.

Does Patellectomy Jeopardize Function After TKA?

Reina Yao MD, Matthew C. Lyons MD, James L. Howard MD, MSc, FRCSC, James P. McAuley MD, FRCSC

The patella provides important mechanical leverage to the knee extensor mechanism. Patellectomy does not exclude the development of tibiofemoral arthrosis.

Rotator Cuff Integrity Correlates With Clinical and Functional Results at a Minimum 16 Years After Open Repair

Martti Vastamäki MD, PhD, Martina Lohman MD, PhD, Niclas Borgmästars MD

Recurrent or persistent defects in the rotator cuff after its repair are common. Short- and medium-term surveys have revealed, after open repair, patients with an intact rotator cuff have increased function and ROM. However, no long-term studies have verified cuff integrity on MR arthrography or correlated it with clinical and functional outcomes.

Parecoxib Added to Ropivacaine Prolongs Duration of Axillary Brachial Plexus Blockade and Relieves Postoperative Pain

Xiaoming Liu PhD, Xuan Zhao MD, Jian Lou MD, Yingwei Wang PhD, Xiaofang Shen MD

Cyclooxygenase (COX)-2 antagonist is widely used for intravenous postoperative pain relief. Recent studies reported COX-2 in the spinal dorsal horn could modulate spinal nociceptive processes. Epidural parecoxib in rats showed no neurotoxicity. These findings suggested applying a COX-2 antagonist directly to the central or peripheral nerve might provide better analgesia.

When Do Readmissions for Infection Occur After Spine and Total Joint Procedures?

Elliot Nacke MD, Nikko Ramos BS, Spencer Stein BS, Lorraine Hutzler BA, Joseph A. Bosco MD

The episode-of-care concept promulgated by the federal government requires hospitals to assume the cost burden for all care rendered up to 30 days after discharge, including all readmissions occurring in that time. Although surgical site infections (SSIs) are a leading cause of readmission after total joint arthroplasties (TJA) and spine surgery, it is unclear whether these readmissions occur relative to the 30-day period.

Estimating Risk in Medicare Patients With THA: An Electronic Risk Calculator for Periprosthetic Joint Infection and Mortality

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

Although risk factors for periprosthetic joint infection (PJI) and mortality after total hip arthroplasty (THA) have been identified, interactions between specific patient risk factors are poorly understood. Therefore, it is difficult for surgeons to counsel patients on their individual risk of PJI or mortality after THA.

Can a Triple Pelvic Osteotomy for Adult Symptomatic Hip Dysplasia Provide Relief of Symptoms for 25 Years?

Renee Anne Stralen MD, Gijs G. Hellemondt MD, PhD, Navin N. Ramrattan MD, Enrico Visser MD, PhD, Marinus Kleuver MD, PhD

Many surgeons recommend pelvic osteotomy to treat symptomatic hip dysplasia in younger patients. We previously reported a cohort of patients at 10 and 15 years followup in which 65% of the patients showed no progression of osteoarthritis (OA).

Intraoperative Cartilage Degeneration Predicts Outcome 12 Months After Hip Arthroscopy

Thorlene Egerton PhD, Rana S. Hinman PhD, Amir Takla MPhy, Kim L. Bennell PhD, John O’Donnell FRACS

When considering arthroscopic surgery for treatment of hip pain, it is important to understand the influence of joint degeneration on the likelihood of success. Previous research has shown poorer outcomes among patients with osteoarthritis but new arthroscopic techniques including femoroacetabular impingement correction and microfracture may lead to better arthroscopic outcomes.

Validation of the Korean Version of the Oxford Knee Score in Patients Undergoing Total Knee Arthroplasty

Il Soo Eun MD, Ok Gul Kim MD, Chang Kyu Kim MD, Hong Seok Lee MD, Jung Sub Lee MD, PhD

Although translated versions of the Oxford Knee Score (OKS) in several languages are available, the absence of a Korean version precludes comparing data from Korea with that from other countries using the OKS.

Is Further Treatment Necessary for Patellar Crepitus After Total Knee Arthroplasty?

Bo-Hyun Hwang MD, Chang-Hyun Nam MD, PhD, Kwang-Am Jung MD, Alvin Ong MD, Su-Chan Lee MD

Patellar crepitus may occur with posterior-stabilized (PS) TKAs. Several studies have suggested numerous etiologies of patellar crepitus after PS-TKA with patellar resurfacing. However, it is unclear whether and to what degree crepitus influences pain and function without or with patellar resurfacing.

Adding Triamcinolone Improves Viscosupplementation: A Randomized Clinical Trial

Gustavo Constantino Campos MD, Marcia U. Rezende MD, PhD, Alexandre F. Pailo MD, Renato Frucchi MD, Olavo Pires Camargo MD, PhD

Intraarticular injections, mainly using long-lasting corticosteroid suspensions, have long been used to treat knee osteoarthritis. Viscosupplementation is a relatively new approach with injection of a variety of agents. When comparing viscosupplementation with intraarticular injections of corticosteroids from baseline to the fourth week, steroids have been more effective for pain relief. By the fourth week they provide similar relief, but beyond that viscosupplementation appears to provide greater pain reduction. The delayed onset of symptomatic improvement combined with reports of reactive synovitis may discourage physicians and patients.

Limb Lengthening and Reconstruction Society AIM Index Reliably Assesses Lower Limb Deformity

James J. McCarthy MD, Christopher A. Iobst MD, S. Robert Rozbruch MD, Sanjeev Sabharwal MD, Emily A. Eismann MS

Although several systems exist for classifying specific limb deformities, there currently are no validated rating scales for evaluating the complexity of general lower limb deformities. Accurate assessment of the complexity of a limb deformity is essential for successful treatment. A committee of the Limb Lengthening and Reconstruction Society (LLRS) therefore developed the LLRS AIM Index to quantify the severity of a broad range of lower extremity deformities in seven domains.

Is Surgery for Spine Metastasis Reasonable in Patients Older Than 60 Years?

Tangzhao Liang MD, PhD, Yong Wan MD, PhD, Xuenong Zou MD, PhD, Xinsheng Peng MD, PhD, Shaoyu Liu MD

Spinal metastases are common in patients older than 60 years with cancer. Because of the uncertainty of survival and the high incidence of fatal complications, however, chemotherapy and radiotherapy generally have been considered preferable and surgery a treatment of last resort for these patients. Further, the selection criteria indicating surgery and reliable prognostic factors for survival remain controversial.

Surgical Technique: Supine Patient Position With the Contralateral Leg Elevated for Femoral Intramedullary Nailing

Ahmet Firat MD, Osman Tecimel MD, Alper Deveci MD, Ali Ocguder MD, Murat Bozkurt

Intramedullary nailing can be performed with a fracture table or manual traction. Manual traction can be applied with the patient in either the supine or lateral decubitus (LD) position. However, in either of these positions, the reduction can be difficult because the fractured extremity is not positioned parallel to the floor and the contralateral leg on the operating room table overlaps the fractured limb while the fractured extremity is in full adduction. Therefore fluoroscopy time may be increased. Accordingly, we developed a technique with the patient supine and the contralateral leg elevated (SCLE).

A Supplemental Video Teaching Tool Enhances Splinting Skills

Saeed Reza Mehrpour MD, Mohamadreza Aghamirsalim MD, Seyed Mohammad Kalantar Motamedi MD, MPH, Fatemeh Ardeshir Larijani MD, Reza Sorbi MD

The ability to apply casts and splints is a technical skill that requires practice and understanding of basic principles of musculoskeletal medicine. A video in which a given procedure is simulated on a dummy can represent reality under controlled conditions. A decrease in physician competency in musculoskeletal medicine is the result of educational deficiencies at the medical school level.

Surgeon Volume is Associated With Cost and Variation in Surgical Treatment of Proximal Humeral Fractures

Nitin B. Jain MD, MSPH, Ifedayo Kuye BS, Laurence D. Higgins MD, Jon J. P. Warner MD

The issue of rising costs will likely dominate the healthcare debate in the forthcoming years.

Bacteria Adhere Less to Barbed Monofilament Than Braided Sutures in a Contaminated Wound Model

John R. Fowler MD, Tiffany A. Perkins BS, Bettina A. Buttaro PhD, Allan L. Truant PhD

Previous studies have found fewer clinical infections in wounds closed with monofilament suture compared with braided suture. Recently, barbed monofilament sutures have shown improved strength and increased timesavings over interrupted braided sutures. However, the adherence of bacteria to barbed monofilament sutures and other commonly used suture materials is unclear.

How Should Unmatched Orthopaedic Surgery Applicants Proceed?

Nirav H. Amin MD, Andre M. Jakoi MD, Douglas L. Cerynik MD, MBA, Neil S. Kumar MD, MBA, Norman Johanson MD

Obtaining an orthopaedic surgery residency is competitive. Advisors must understand what factors may help unmatched candidates reapply successfully.

Case Report: Curetting Osteoid Osteoma of the Spine Using Combined Video-assisted Thoracoscopic Surgery and Navigation

Wuilker Knoner Campos MD, Alessandro Gasbarrini MD, Stefano Boriani MD

A spinal osteoid osteoma is a rare benign tumor. The usual treatment involves complete curettage including the nidus. In the thoracic spine, conventional open surgical treatment usually carries relatively high surgical risks because of the close anatomic relationship to the spinal cord, nerve roots, and thoracic vessels, and pulmonary complications and postoperative pain.

Reply to Letter to the Editor: Critically Assessing the Haiti Earthquake Response and the Barriers to Quality Orthopaedic Care

Daniel A. Sonshine BA, Amber Caldwell BA, Rich A. Gosselin MD, MPH, MSc, Christopher T. Born MD, R. Richard Coughlin MD, MSc

Erratum to: Reply to Letter to the Editor: Critically Assessing the Haiti Earthquake Response and the Barriers to Quality Orthopaedic Care

Daniel A. Sonshine BA, Amber Caldwell BA, Rich A. Gosselin MD, MPH, MSc, Christopher T. Born MD, R. Richard Coughlin MD, MSc
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