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 7 | Jul, 2013

A Review of Current Fixation Use and Registry Outcomes in Total Hip Arthroplasty: The Uncemented Paradox

Anders Troelsen MD, PhD, DMSc, Erik Malchau MD, Nanna Sillesen MD, Henrik Malchau MD, PhD

The majority (86%) of THAs performed in the United States are uncemented. This may increase the revision burden if uncemented fixation is associated with a higher risk of revision than other approaches.

Asymptomatic Upper Arm Mass in a 37-year-old Woman

Paul Rothenberg BA, Yaxia Zhang MD, PhD, Andrew Rosenberg MD, Sheila A. Conway MD

Severe Metal-induced Osteolysis Many Years After Unipolar Hip Endoprosthesis

Matthew A. Mann MD, Dylan Tanzer DEC, Michael Tanzer MD

Modularity of the femoral head-neck junction provides increased intraoperative flexibility to the surgeon. Complications of this modularity include damage to the trunnion, with subsequent bone and/or soft tissue loss from adverse reactions to metal debris.

What Are the Risks of Prophylactic Pinning to Prevent Contralateral Slipped Capital Femoral Epiphysis?

Wudbhav N. Sankar MD, Eduardo N. Novais MD, Christopher Lee MD, Ali A. Al-Omari MD, Paul D. Choi MD, Benjamin J. Shore MD, FRCSC

Two decision analyses on managing the contralateral, unaffected hip after unilateral slipped capital femoral epiphysis (SCFE) have failed to yield consistent recommendations. Missing from both, however, are sufficient data on the risks associated with prophylactic pinning using modern surgical techniques.

The Fate of Hips That Are Not Prophylactically Pinned After Unilateral Slipped Capital Femoral Epiphysis

Yaser M. K. Baghdadi MD, A. Noelle Larson MD, Rafael J. Sierra MD, Hamlet A. Peterson MD, Anthony A. Stans MD

The indications for prophylactic pinning of the contralateral hip after unilateral slipped capital femoral epiphysis (SCFE) remain controversial in part because the natural history of the contralateral hip is unclear.

Patients With Unstable Slipped Capital Femoral Epiphysis Have Antecedent Symptoms

Thomas G. McPartland MD, Wudbhav N. Sankar MD, Young-Jo Kim MD, PhD, Michael B. Millis MD

The characteristics of patients who sustain unstable slipped capital femoral epiphyses (SCFEs) are not well described compared to their counterparts who sustain stable SCFE. Although patients with unstable slips are usually identified owing to acute symptoms, it is unclear whether these patients have premonitory symptoms that could heighten the awareness of treating physicians to the possibility of an unstable slip and lead to timely diagnosis and treatment.

A Reduction in Body Mass Index Lowers Risk for Bilateral Slipped Capital Femoral Epiphysis

Adam Y. Nasreddine MA, Benton E. Heyworth MD, David Zurakowski PhD, Mininder S. Kocher MD, MPH

Slipped capital femoral epiphysis (SCFE) is occurring in greater numbers, at increasingly younger ages, and more frequently bilaterally (BL-SCFE). Obesity is one risk factor for SCFE. However, it is unclear whether postoperative decreases or increases in body mass index (BMI) alter the risk of subsequent contralateral SCFE.

Is the Acetabulum Retroverted in Slipped Capital Femoral Epiphysis?

Shafagh Monazzam MD, Venkatadass Krishnamoorthy MD, Bernd Bittersohl MD, James D. Bomar MPH, Harish S. Hosalkar MD

Recent biplanar radiographic studies have demonstrated acetabular retroversion and increased superolateral femoral head coverage in hips with slipped capital femoral epiphysis (SCFE), seemingly divergent from earlier CT-based studies suggesting normal acetabular version.

Increased Acetabular Depth May Influence Physeal Stability in Slipped Capital Femoral Epiphysis

David A. Podeszwa MD, David Gurd MD, Anthony Riccio MD, Adriana Rocha MS, Daniel J. Sucato MD, MS

Multiple mechanical factors affecting the hip have been associated with the development of slipped capital femoral epiphysis (SCFE). Whether acetabular depth plays a role in the development of a SCFE has not been elucidated.

Slipped Capital Femoral Epiphysis: Relevant Pathophysiological Findings With Open Surgery

Kai Ziebarth MD, Michael Leunig MD, Theddy Slongo MD, Young-Jo Kim MD, PhD, Reinhold Ganz MD

Traditionally arthrotomy has rarely been performed during surgery for slipped capital femoral epiphysis (SCFE). As a result, most pathophysiological information about the articular surfaces was derived clinically and radiographically. Novel insights regarding deformity-induced damage and epiphyseal perfusion became available with surgical hip dislocation.

Case Reports: Acetabular Damage After Mild Slipped Capital Femoral Epiphysis

Cara Beth Lee MD, Travis Matheney MD, Yi-Meng Yen MD, PhD

Slipped capital femoral epiphysis (SCFE) is a common hip problem in adolescents that results in a cam-type femoroacetabular impingement (FAI) deformity. Although the treatment for mild (slip angle of 0°–30°) and moderate (slip angle of 31°–60°) SCFE has historically been in situ fixation, recent studies have demonstrated impingement-related articular damage, irrespective of slip severity. Our series confirms previous reports that acetabular chondral injury occurs in mild to low-moderate (slip angle of ≤ 40°) SCFE.

Symptomatic Femoroacetabular Impingement: Does the Offset Decrease Correlate With Cartilage Damage? A Pilot Study

Christoph Zilkens MD, Falk Miese MD, Rüdiger Krauspe MD, Bernd Bittersohl MD

Current measures of the reduced head-neck offset such as residual deformity of slipped capital femoral epiphysis (SCFE) including the alpha angle, which measures the femoral head-neck sphericity but does not account for acetabular abnormalities, do not represent the true magnitude of the deformity and the mechanical consequences. The beta angle (angle between the femoral head-neck junction and acetabular rim) accounts for the morphology of both the acetabulum and femur and, thus, may be the more appropriate parameter for assessing SCFE deformity.

Postoperative Improvement of Femoroacetabular Impingement After Intertrochanteric Flexion Osteotomy for SCFE

Takashi Saisu MD, PhD, Makoto Kamegaya MD, PhD, Yuko Segawa MD, PhD, Jun Kakizaki MD, Kazuhisa Takahashi MD, PhD

Patients with slipped capital femoral epiphysis (SCFE) may develop cam-type femoroacetabular impingement (FAI). Early management of FAI has been advocated for patients with symptomatic FAI. The various treatment options, including reorientation surgeries, realignment procedures, and osteoplasty, remain controversial.

Unstable SCFE: Review of Treatment Modalities and Prevalence of Osteonecrosis

Ira Zaltz MD, Geneva Baca PhD, John C. Clohisy MD

The treatment of unstable slipped capital femoral epiphysis (SCFE) is rapidly evolving with the ability to correct epiphyseal alignment using the modified Dunn technique. Adopting a new treatment method depends on confirming that it achieves its goals, produces few, nonserious complications with no lasting sequelae, and improves the natural history of the disorder compared with known treatment methods. As such, the rates of osteonecrosis and complications after current treatments of unstable SCFE must be compared with those of newer surgical techniques.

Closed Bone Graft Epiphysiodesis for Avascular Necrosis of the Capital Femoral Epiphysis

George H. Thompson MD, Ethan S. Lea MD, MS, Kenneth Chin MD, Raymond W. Liu MD, Jochen P. Son-Hing MD, Allison Gilmore MD

Avascular necrosis (AVN) of the capital femoral epiphysis (CFE) after an unstable slipped capital femoral epiphysis (SCFE), femoral neck fracture or traumatic hip dislocation can result in severe morbidity. Treatment options for immature patients with AVN are limited, including a closed bone graft epiphysiodesis (CBGE). However, it is unclear whether this procedure prevents AVN progression.

Vascularized Fibular Grafts for Avascular Necrosis After Slipped Capital Femoral Epiphysis: Is Hip Preservation Possible?

Todd Bertrand MD, James R. Urbaniak MD, Robert K. Lark MD, MS

Avascular necrosis (AVN) of the femoral head is a potential complication in patients with slipped capital femoral epiphysis (SCFE), radiographically occurring in 3–60%. This may lead to early hip fusion or hip arthroplasty. Free vascularized fibular grafting (FVFG) may provide a reasonable means to preserve the femoral head.

Coexisting Intraarticular Disorders Are Unrelated To Outcomes After Arthroscopic Resection of Dorsal Wrist Ganglions

Ho Jung Kang MD, PhD, Il Hyun Koh MD, Ji Sub Kim MD, Yun Rak Choi MD, PhD

Dorsal wrist ganglions are one of the most frequently encountered problems of the wrist and often are associated with intraarticular disorders. However, it is unclear whether coexisting intraarticular disorders influence persistent pain or recurrence after arthroscopic resection of dorsal wrist ganglions.

Surgical Technique: Hemilaminectomy and Unilateral Lateral Mass Fixation for Cervical Ossification of the Posterior Longitudinal Ligament

Kun Liu MD, Jiangang Shi MD, Lianshun Jia MD, Wen Yuan MD

Surgical approaches for cervical ossification of the posterior longitudinal ligament (OPLL) include anterior, posterior, or combined decompression with or without fusion. The goal of surgery is to decompress the spinal cord while maintaining the stability and sagittal alignment of the cervical spine. C5 palsy has been reported as a postoperative complication of cervical laminectomy or laminoplasty characterized as motor weakness of the muscles supplied with C5 nerve roots. Several studies have shown this phenomenon was partially attributable to posterior shift of spinal cord.

Surgical Technique: Results of Stabilization of Sternoclavicular Joint Luxations Using a Polydioxanone Envelope Plasty

Jean W. M. Gardeniers MD, PhD, Jan Burgemeester MD, Jaap Luttjeboer MD, Wim H. C. Rijnen MD, PhD

Surgical treatment options for sternoclavicular joint luxations described in the literature are numerous, although all have limitations. Therefore, there is no favorable surgical treatment for sternoclavicular luxations when nonoperative treatment has failed.

Lateral Center-edge Angle on Conventional Radiography and Computed Tomography

Shafagh Monazzam MD, James D. Bomar MPH, Krishna Cidambi MD, Peter Kruk MD, Harish Hosalkar MD

Lateral center-edge angle (LCEA), originally described and validated on AP radiographs, has been used increasingly in CT-based studies, but it is unclear whether the measure is reliable and whether it correlates with that on AP radiographs.

Wear of a 5 Megarad Cross-linked Polyethylene Liner: A 6-year RSA Study

Stuart A. Callary BAppSc, David G. Campbell BMBS, FRACS, PhD, Graham Mercer BMBS, FRACS, Kjell G. Nilsson MD, PhD, FRACS, John R. Field MSc, BVSc, DVSc, PhD

One cross-linked polyethylene (XLPE) liner is manufactured using a lower dose of radiation, 5 Mrad, which may result in less cross-linking. The reported in vivo wear rate of this XLPE liner in patients undergoing THA has varied, and has included some patients in each reported cohort who had greater than 0.1 mm/year of wear, which is an historical threshold for osteolysis. Previous studies have measured wear on plain radiographs, an approach that has limited sensitivity.

Skin Crease ‘Bikini’ Incision for Anterior Approach Total Hip Arthroplasty: Surgical Technique and Preliminary Results

Michael Leunig MD, Michael Faas MD, Fabian Knoch MD, Florian D. Naal MD

The direct anterior approach for THA allows implantation through an internervous plane without muscle detachment from bone. However, the classic longitudinal skin incision does not follow the anatomic skin creases and can result in scar widening. We therefore modified our incision technique to a short oblique skin incision following the anatomic skin crease of the groin.

Is Arthroplasty Immediately After an Infected Case a Risk Factor for Infection?

Mansour Abolghasemian MD, Amir Sternheim MD, Alireza Shakib MD, Oleg A. Safir MD, David Backstein MD

It is common practice in many centers to avoid performing a clean case in a room in which an infected procedure has just taken place. No studies of which we are aware speak to the necessity of this precaution.

Validity and Reliability of the Paprosky Acetabular Defect Classification

Raymond Yu BM, BS, HB.MedSc, M.SurgSci, Jochen G. Hofstaetter MD, Thomas Sullivan BMa&CompSc(Hons), Kerry Costi BA, Donald W. Howie BM, BS, PhD, FRACS, Lucian B. Solomon MD, PhD, FRACS

The Paprosky acetabular defect classification is widely used but has not been appropriately validated. Reliability of the Paprosky system has not been evaluated in combination with standardized techniques of measurement and scoring.

Is a Positive Femoroacetabular Impingement Test a Common Finding in Healthy Young Adults?

Lene B. Laborie MD, Trude G. Lehmann MD, Ingvild Ø. Engesæter MD, Lars B. Engesæter MD, PhD, Karen Rosendahl MD, PhD

Femoroacetabular impingement (FAI) is an incompletely understood clinical concept that implies pathomechanical changes in the hip as a cause for hip-related pain in young adults. While a positive anterior impingement test is suggestive of FAI, its association with clinical and radiographic findings remain unconfirmed in healthy young adults.

Cylindrical Axis, Not Epicondyles, Approximates Perpendicular to Knee Axes

Clifton W. Hancock MS, MD, Mark J. Winston MD, Joel M. Bach PhD, Bradley S. Davidson PhD, Donald G. Eckhoff MS, MD

The transepicondylar axis (TEA) is often used as a surrogate for the flexion-extension axis, ie, the axis around which the tibia moves in space, because of a belief that both axes lie perpendicular to the mechanical axis. However, studies suggest the cylindrical axis (CA), defined as a line equidistant from contact points on the medial and lateral condylar surfaces from 10to 120flexion, more closely approximates the axis around which the tibia moves in space.

Periarticular Injection in Knee Arthroplasty Improves Quadriceps Function

Arnaud Chaumeron MD, Daniel Audy MD, Pierre Drolet MD, MSc, Martin Lavigne MD, MSc, Pascal-André Vendittoli MD, MSc

The postoperative analgesic potential of periarticular anesthetic infiltration (PAI) after TKA is unclear as are the complications of continuous femoral nerve block on quadriceps function.

Reason for Revision TKA Predicts Clinical Outcome: Prospective Evaluation of 150 Consecutive Patients With 2-years Followup

Robin W. T. M. Kempen MD, Janneke J. P. Schimmel MSc, Gijs G. Hellemondt MD, Hilde Vandenneucker MD, Ate B. Wymenga MD, PhD

There is limited knowledge regarding the relationship between the reason for revising a TKA and the clinical outcome in terms of satisfaction, pain, and function with time.

The SERI Distal Metatarsal Osteotomy and Scarf Osteotomy Provide Similar Correction of Hallux Valgus

Sandro Giannini MD, Marco Cavallo MD, Cesare Faldini MD, Deianira Luciani MD, Francesca Vannini MD, PhD

Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures.

Material and Biofilm Load of K Wires in Toe Surgery: Titanium versus Stainless Steel

Martin Clauss MD, Susanne Graf MD, Silke Gersbach Dipl Sportscience, Beat Hintermann MD, Thomas Ilchmann MD, PhD, Markus Knupp MD

Recurrence rates for toe deformity correction are high and primarily are attributable to scar contractures. These contractures may result from subclinical infection.

Osteonecrosis Complicating Developmental Dysplasia of the Hip Compromises Subsequent Acetabular Remodeling

Andreas Roposch MD, MSc, FRCS, Deborah Ridout MSc, Evangelia Protopapa MSc, Nicholas Nicolaou FRCS, Yael Gelfer MD, PhD

Osteonecrosis of the femoral head secondary to treatment of developmental dysplasia of the hip (DDH) affects acetabular remodeling but the magnitude of this effect is unclear.

The Influence of Botulinum Toxin A Injections into the Calf Muscles on Genu Recurvatum in Children With Cerebral Palsy

Matthias C. M. Klotz MD, Sebastian I. Wolf PhD, Daniel Heitzmann MSc, Simone Gantz MSc, Frank Braatz MD, Thomas Dreher MD

With cerebral palsy (CP), an equinus deformity may lead to genu recurvatum. Botulinum toxin A (BtA) injection into the calf muscles is a well-accepted treatment for dynamic equinus deformity.

Extensor Function After Medial Gastrocnemius Flap Reconstruction of the Proximal Tibia

Thorsten Jentzsch MD, Matthias Erschbamer MD, PhD, Franziska Seeli, Bruno Fuchs MD, PhD

Reconstruction of the extensor mechanism after resection of the proximal tibia is challenging, and several methods are available. A medial gastrocnemius flap commonly is used, although it may be associated with an extensor lag. This problem also is encountered, although perhaps to a lesser extent, with other techniques for reconstruction of the extensor apparatus. It is not known how such lag develops with time and how it correlates with functional outcome.

Role of Interleukin-6 as an Early Marker of Fat Embolism Syndrome: A Clinical Study

Shiva Prakash SS, MS, Ramesh Kumar Sen MS, DNB, PhD, Sujit Kumar Tripathy MS, DNB, MNAMS, Indu Mohini Sen MD, R. R. Sharma MD, Sadhna Sharma MD

A few animal studies have shown that IL-6 can serve as an early marker of fat embolism syndrome. The degree to which this is true in human trauma victims is unknown.

Scheduled Analgesic Regimen Improves Rehabilitation After Hip Fracture Surgery

Raymond Ping-Hong Chin FRCS, FHKAM, FHKCOS, Chin-Hung Ho FRCSE (Orth), FHKAM, FHKCOS, Lydia Po-Chee Cheung MSN

Postoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery.

Comparison of the Cable Pin System With Conventional Open Surgery for Transverse Patella Fractures

Ningfang Mao MD, Deding Liu MD, Haijian Ni MD, Hao Tang MD, Qiulin Zhang MD

The cable pin system is an effective device for fixation of transverse patella fractures. However, whether this device provides superior results using a minimally invasive technique instead of conventional open surgery using the K wire tension band method is unclear.

Impact of Preoperative MRSA Screening and Decolonization on Hospital-acquired MRSA Burden

Sapna Mehta MD, Scott Hadley MD, Lorraine Hutzler BA, James Slover MD, MS, Michael Phillips MD, Joseph A. Bosco MD

Hospital-acquired infections caused by methicillin-resistant(MRSA) are a source of morbidity and the most common pathogen in prosthetic joint infections and the incidence of MRSA is increasing.

Success After Treatment of Periprosthetic Joint Infection: A Delphi-based International Multidisciplinary Consensus

Claudio Diaz-Ledezma MD, Carlos A. Higuera MD, Javad Parvizi MD, FRCS

The lack of agreement regarding what constitutes successful treatment for periprosthetic joint infections (PJI) makes it difficult to compare the different strategies of management that are used in clinical practice and in research studies.

Staphylococcus aureus Screening and Decolonization in Orthopaedic Surgery and Reduction of Surgical Site Infections

Antonia F. Chen MD, MBA, Charles B. Wessel MLS, Nalini Rao MD

Staphylococcus aureus is the most common organism responsible for orthopaedic surgical site infections (SSIs). Patients who are carriers for methicillin-sensitive S. aureus or methicillin-resistant S. aureus (MRSA) have a higher likelihood of having invasive S. aureus infections. Although some have advocated screening for S. aureus and decolonizing it is unclear whether these efforts reduce SSIs.

Isoniazid Could Be Used for Antibiotic-loaded Bone Cement for Musculoskeletal Tuberculosis: An In Vitro Study

Chang Dong Han MD, PhD, Taegwon Oh RPH, PhD, Sang-Nae Cho DVM, PhD, Jae Ho Yang MD, Kwan Kyu Park MD, PhD

Antibiotic-loaded bone cement (ALBC) has been used in serious cases of musculoskeletal tuberculosis, but the type and amount of antibiotic that should be used in ALBC have not been determined.

Erratum to: 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
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