Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 472 | Issue 3 | Mar, 2014
Articles

Magnetic Resonance Imaging of the Hip: Poor Cost Utility for Treatment of Adult Patients With Hip Pain

James A. Keeney MD, Ryan M. Nunley MD, Muyibat Adelani MD, Nathan Mall MD

Although MRI is frequently used to diagnose conditions affecting the hip, its cost-effectiveness has not been defined.

A Dual-center Review of Compressive Osseointegration for Fixation of Massive Endoprosthetics: 2- to 9-year Followup

George T. Calvert MD, Judd E. Cummings MD, Austin J. Bowles MS, Kevin B. Jones MD, L. Daniel Wurtz MD, R. Lor Randall MD

Aseptic failure of massive endoprostheses used in the reconstruction of major skeletal defects remains a major clinical problem. Fixation using compressive osseointegration was developed as an alternative to cemented and traditional press-fit fixation in an effort to decrease aseptic failure rates.

Silver Negative Pressure Dressing With Vacuum-assisted Closure of Massive Pelvic and Extremity Wounds

Herrick J. Siegel MD, Diego F. Herrera MD, Jason Gay CRNFA

Massive soft tissue loss involving the pelvis and extremities from trauma, infections, and tumors remains a challenging and debilitating problem. Although vacuum-assisted closure (VAC) technology is effective in the management of soft tissue loss, the adjunct of a silver dressing in the setting of massive wounds has not been as well tested.

Frozen Section versus Gross Examination for Bone Marrow Margin Assessment During Sarcoma Resection

Megan E. Anderson MD, Patricia E. Miller MS, Kelsey Nostrand BS, Sara O. Vargas MD

Complete resection is critical for local control of primary bone sarcomas. Intraoperative consultation, including frozen section of bone marrow margins, frequently is used to aid in this goal.

How Long Should We Follow Patients With Soft Tissue Sarcomas?

Chigusa Sawamura MD, MPH, Seiichi Matsumoto MD, PhD, Takashi Shimoji MD, PhD, Atsushi Okawa MD, PhD, Keisuke Ae MD, PhD

Guidelines suggest that followup for low-grade soft tissue sarcomas should be every 3 to 6 months for 2 to 3 years and then annually, and for high-grade sarcomas every 3 to 6 months for 2 to 5 years, then every 6 months for the next 2 years, and then annually. However, there is only very limited evidence to support these strategies.

Chemotherapy Influences the Pseudocapsule Composition in Soft Tissue Sarcomas

Patrick W. O’Donnell MD, PhD, J. Carlos Manivel MD, Edward Y. Cheng MD, Denis R. Clohisy MD

Soft tissue sarcomas are a heterogeneous group of malignant tumors. Standard treatment for soft tissue sarcoma of the extremity is surgical excision and adjuvant therapy; however, the role of neoadjuvant chemotherapy is controversial.

Radiation Therapy Is Associated With Fewer Recurrences in Mesenchymal Chondrosarcoma

Satoshi Kawaguchi MD, Israel Weiss MD, Patrick P. Lin MD, Winston W. Huh MD, Valerae O. Lewis MD

Mesenchymal chondrosarcoma (MSC) is a rare variant of chondrosarcoma. Because of the rarity of the disease, most studies only contain a small number of patients and thus the prognostic variables and role of adjuvant therapies remain controversial.

Chick Embryo Extract Demethylates Tumor Suppressor Genes in Osteosarcoma Cells

Xiaodong Mu PhD, Bolat Sultankulov BS, Riddhima Agarwal, Adel Mahjoub, Trevor Schott BS, Nicholas Greco MD, Johnny Huard PhD, Kurt Weiss MD

Epigenetics is the study of changes in gene expression or cellular phenotype caused by mechanisms other than changes in the underlying DNA sequence. It is widely accepted that cancer has genetic and epigenetic origins. The idea of epigenetic reprogramming of cancer cells by an embryonic microenvironment possesses potential interest from the prospect of both basic science and potential therapeutic strategies. Chick embryo extract (CEE) has been used for the successful expansion of many specific stem cells and has demonstrated the ability to facilitate DNA demethylation.

Loss of SS18-SSX1 Inhibits Viability and Induces Apoptosis in Synovial Sarcoma

Emily E. Carmody Soni MD, Silke Schlottman PhD, Hayriye V. Erkizan PhD, Aykut Uren MD, Jeffrey A. Toretsky MD

Most synovial sarcomas contain a chromosomal translocation t(X;18), which results in the formation of an oncoprotein SS18-SSX critical to the viability of synovial sarcoma.

Factors That Influence the Choice to Undergo Surgery for Shoulder and Elbow Conditions

Chetan S. Modi MSc, FRCS (Tr&Orth), Christian J. H. Veillette MD, MSc, Rajiv Gandhi MD, MSc, Anthony V. Perruccio PhD, Y. Raja Rampersaud MD

Knowledge of the factors that influence the willingness of patients considering elective orthopaedic surgery is essential for patient-centered care. To date, however, these factors remain undefined in the orthopaedic population with shoulder and elbow disorders.

Axillary View: Arthritic Glenohumeral Anatomy and Changes After Ream and Run

Frederick A. Matsen MD, Akash Gupta MD

The technique and results of shoulder arthroplasty are influenced by glenohumeral pathoanatomy. Although some authors advocate a routine preoperative CT scan to define this anatomy, ordering a CT scan substantially increases the cost and the radiation exposure for the patient.

Symptomatic Pulmonary Embolus After Joint Arthroplasty: Stratification of Risk Factors

Javad Parvizi MD, Ronald Huang MD, Ibrahim J. Raphael MD, William V. Arnold MD, PhD, Richard H. Rothman MD, PhD

Prophylaxis for pulmonary embolism (PE) after total joint arthroplasty (TJA) presents the clinical dilemma of balancing the risk of postoperative thrombotic risk and anticoagulation-related complications such as bleeding, hematoma formation, and infection. Risk stratification of patients undergoing TJA is needed to tailor prophylaxis based on thrombotic and bleeding risk.

Does an Unloader Brace Reduce Knee Loading in Normally Aligned Knees?

Jay R. Ebert PhD, Karen Hambly PhD, Brendan Joss PhD, Timothy R. Ackland PhD, Cyril J. Donnelly PhD

Unloading knee braces often are used after tibiofemoral articular cartilage repair. However, the experimental basis for their use in patients with normal tibiofemoral alignment such as those undergoing cartilage repair is lacking.

Industrially Prefabricated Cement Spacers: Do Vancomycin- and Gentamicin-impregnated Spacers Offer Any Advantage?

Pablo S. Corona MD, Victor Barro MD, Marye Mendez MD, Enric Cáceres PhD, Xavier Flores MD

Industrially preformed antibiotic-loaded cement spacers are useful to facilitate the second stage of two-stage exchange arthroplasty for infected THAs and TKAs. However, whether gentamicin alone or a combination of antibiotics (such as vancomycin and gentamicin) is more effective is not known.

Total Hip Arthroplasty Performed in Patients with Residual Poliomyelitis: Does it Work?

Byung-Ho Yoon MD, Young-Kyun Lee MD, Jeong Joon Yoo MD, PhD, Hee Joong Kim MD, Kyung-Hoi Koo MD

Patients with residual poliomyelitis can have advanced degenerative arthritis of the hip in the paralytic limb or the nonparalytic contralateral limb. Although THA is a treatment option for some of these patients, there are few studies regarding THA in this patient population.

Long-term Results and Bone Remodeling After THA With a Short, Metaphyseal-fitting Anatomic Cementless Stem

Young-Hoo Kim MD, Jang-Won Park MD, Jun-Shik Kim MD, Jun-Seok Kang MD

Long-term results of standard total hip arthroplasty (THA) in young patients were not optimal. There are a number of reported disadvantages to longer cementless stems in THA including thigh pain and proximal stress shielding. However, it is unknown whether a short, metaphyseal-fitting anatomic stem without diaphyseal fixation, which represents a possible alternative, will maintain fixation over the longer term.

High Metal Ion Levels After Use of the ASR™ Device Correlate With Development of Pseudotumors and T Cell Activation

Nils P. Hailer Dr, Med, Mats Bengtsson PhD, Christina Lundberg MD, Jan Milbrink PhD

Pseudotumors and immunologic alterations are reported in patients with elevated metal ion levels after resurfacing arthroplasty of the hip. A direct association of increased cobalt and chromium concentrations with the development of pseudotumors has not been established.

Efficacy of Revision Surgery for the Dislocating Total Hip Arthroplasty: Report From a Large Community Registry

Tiare Salassa MD, Daniel Hoeffel MD, Susan Mehle BS, Penny Tatman MPH, Terence J. Gioe MD

Historically, achieving stability for the unstable total hip arthroplasty (THA) with revision surgery has been achieved inconsistently. Most of what we know about this topic comes from reports of high-volume surgeons’ results; the degree to which these results are achieved in the community is largely unknown, but insofar as most joint replacements are done by community surgeons, the issue is important.

Does Obesity Affect the Surgical Outcome and Complication Rates of Spinal Surgery? A Meta-analysis

Jin Jiang MD, Yuanjun Teng MD, Zhenzhen Fan MD, Shahidur Khan MD, Yayi Xia MD, PhD

As obesity becomes more prevalent, it becomes more common among patients considering orthopaedic surgery, including spinal surgery. However, there is some controversy regarding whether obesity is associated with complications, failed reconstructions, or reoperations after spinal surgery.

Adverse Reactions of Artificial Bone Graft Substitutes: Lessons Learned From Using Tricalcium Phosphate geneX®

Joerg Friesenbichler MD, Werner Maurer-Ertl MD, Patrick Sadoghi MD, Ulrike Pirker-Fruehauf MD, Koppany Bodo MD, Andreas Leithner MD

Artificial bone graft substitutes are widely used to fill bony defects after curettage of benign tumors. We sought to evaluate the efficacy of one such bone graft substitute, geneX, which contains tricalcium phosphate and calcium sulphate; however, during the course of this study we observed a high number of complications.

Does Ifosfamide Therapy Improve Survival of Patients With Dedifferentiated Chondrosarcoma?

Satoshi Kawaguchi MD, Tao Sun MD, Patrick P. Lin MD, Michael Deavers MD, Nusrat Harun PhD, Valerae O. Lewis MD

Dedifferentiated chondrosarcoma remains a significant therapeutic challenge. Studies performed to date have not identified efficacious chemotherapy regimens for this disease.

Meniscal Injury After Adolescent Anterior Cruciate Ligament Injury: How Long Are Patients at Risk?

Zachary D. Guenther MD, Vimarsha Swami BSc, Sukhvinder S. Dhillon MB, ChB, MRCP, FRCR, Jacob L. Jaremko MD, PhD, FRCPC

Delay of as much as 5 months between ACL injury and surgery is known to be associated with increased risk of a medial meniscal tear, but the risk of additional meniscal tear progression with a longer delay to surgery is unclear.

Comparison of Acetabular Anterior Coverage After Salter Osteotomy and Pemberton Acetabuloplasty: A Long-term Followup

Cheng-Wei Wang MD, Kuan-Wen Wu MD, Ting-Ming Wang MD, PhD, Shier-Chieg Huang MD, PhD, Ken N. Kuo MD

The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered.

Association of a Modified Frailty Index With Mortality After Femoral Neck Fracture in Patients Aged 60 Years and Older

Kushal V. Patel MD, Kindyle L. Brennan PhD, Michael L. Brennan MD, Daniel C. Jupiter PhD, Adam Shar MD, Matthew L. Davis MD

Frailty, a multidimensional syndrome entailing loss of energy, physical ability, cognition, and health, plays a significant role in elderly morbidity and mortality. No study has examined frailty in relation to mortality after femoral neck fractures in elderly patients.

Are Race and Sex Associated With the Occurrence of Atypical Femoral Fractures?

Alejandro Marcano MD, David Taormina BS, Kenneth A. Egol MD, Valerie Peck MD, Nirmal C. Tejwani MD

Prior studies have suggested that Asian patients and women may be more likely to sustain atypical femoral fractures in association with bisphosphonate use. However, they do not account for confounders such as asymptomatic patients who are long-term bisphosphonate users or patients sustaining osteoporotic fractures.

High-energy Femur Fractures Increase Morbidity but not Mortality in Elderly Patients

Kushal V. Patel MD, Kindyle L. Brennan PhD, Matthew L. Davis MD, Daniel C. Jupiter PhD, Michael L. Brennan MD

Trauma centers are projected to have an increase in the number of elderly patients with high-energy femur fractures. Greater morbidity and mortality have been observed in these patients. Further clarification regarding the impact of high-energy femur fractures is necessary in this population.

Single- or Two-stage Revision for Infected Total Hip Arthroplasty? A Systematic Review of the Literature

Hugh A. C. Leonard MA, BMBCh, Alexander D. Liddle BSc, MRCS, Órlaith Burke PhD, David W. Murray MD, FRCS(Orth), Hemant Pandit FRCS(Orth), DPhil

The best approach for surgical treatment of an infected THA remains controversial. Two-stage revision is believed to result in lower reinfection rates but may result in significant functional impairment. Some authors now suggest that single-stage revision may provide comparable results in terms of infection eradication while providing superior functional outcomes.

Erratum to: Mesenchymal Stem Cells in Synovial Fluid Increase After Meniscus Injury

Yu Matsukura MD, Takeshi Muneta MD, PhD, Kunikazu Tsuji PhD, Hideyuki Koga MD, PhD, Ichiro Sekiya MD, PhD
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