Clinical Orthopaedics and Related Research ®

A Publication of The Association of Bone and Joint Surgeons ®

Published in
Clinical Orthopaedics and Related Research®
Volume 474 | Issue 5 | May, 2016

Universal Health Insurance Coverage in Massachusetts Did Not Change the Trajectory of Arthroplasty Use or Costs

Steven M. Kurtz PhD, Edmund Lau MS, Kevin L. Ong PhD, Jeffrey N. Katz MD, Kevin J. Bozic MD, MBA

The state of Massachusetts enacted universal health insurance in 2006. However it is unknown whether the increased access to care resulted in changes to surgical use or costs.

What Risk Factors and Characteristics Are Associated With Late-presenting Dislocations of the Hip in Infants?

Kishore Mulpuri MBBS, MS(Ortho), MHSc(Epi), Emily K. Schaeffer PhD, Janice Andrade BSW, Wudbhav N. Sankar MD, Nicole Williams BMedSc, FRACS(Ortho), Travis H. Matheney MD, MLA, Scott J. Mubarak MD, Peter J. Cundy MBBS, FRACS, Charles T. Price MD, FAAP

Most infants with developmental dysplasia of the hip (DDH) are diagnosed within the first 3 months of life. However, late-presenting DDH (defined as a diagnosis after 3 months of age) does occur and often results in more complex treatment and increased long-term complications. Specific risk factors involved in late-presenting DDH are poorly understood, and clearly defining an associated set of factors will aid in screening, detection, and prevention of this condition.

What Is the Impact of Center Variability in a Multicenter International Prospective Observational Study on Developmental Dysplasia of the Hip?

Kishore Mulpuri MBBS, MS(Ortho) MHSc(Epi), Emily K. Schaeffer PhD, Simon P. Kelley MBChB, FRCS (Tr and Ortho), Pablo Castañeda MD, Nicholas M. P. Clarke ChM, DM, FRCS, FRCS Ed, Jose A. Herrera-Soto MD, Vidyadhar Upasani MD, Unni G. Narayanan MBBS, MSc, FRCSC, Charles T. Price MD, FAAP

Little information exists concerning the variability of presentation and differences in treatment methods for developmental dysplasia of the hip (DDH) in children < 18 months. The inherent advantages of prospective multicenter studies are well documented, but data from different centers may differ in terms of important variables such as patient demographics, diagnoses, and treatment or management decisions. The purpose of this study was to determine whether there is a difference in baseline data among the nine centers in five countries affiliated with the International Hip Dysplasia Institute to establish the need to consider the center as a key variable in multicenter studies.

Success of Pavlik Harness Treatment Decreases in Patients ≥ 4 Months and in Ultrasonographically Dislocated Hips in Developmental Dysplasia of the Hip

Hakan Ömeroğlu MD, Nusret Köse MD, Anil Akceylan MD

Treatment of developmental dysplasia of the hip (DDH) using the Pavlik harness has been a widely used method in patients between 0 and 6 months of age for many years. However, the factors influencing the success rate of this treatment modality have still not exactly been determined as a result of the limited number of clinical studies with higher level of evidence.

Does Perfusion MRI After Closed Reduction of Developmental Dysplasia of the Hip Reduce the Incidence of Avascular Necrosis?

Alex L. Gornitzky BS, Andrew G. Georgiadis MD, Mark A. Seeley MD, B. David Horn MD, Wudbhav N. Sankar MD

Gadolinium-enhanced perfusion MRI (pMRI) after closed reduction/spica casting for developmental dysplasia of the hip (DDH) has been suggested as a potential means to identify and avoid avascular necrosis (AVN). To date, however, no study has evaluated the effectiveness of pMRI in clinical practice or compared it with other approaches (such as postreduction CT scan) to show a difference in the proportion of AVN.

Is Age or Surgical Approach Associated With Osteonecrosis in Patients With Developmental Dysplasia of the Hip? A Meta-analysis

Eduardo N. Novais MD, Mary K. Hill BA, Patrick M. Carry BA, Patricia C. Heyn MS, PhD

Osteonecrosis of the femoral head is a major complication that negatively impacts the clinical and radiographic long-term outcome after treatment of developmental hip dysplasia (DDH). There are conflicting results in the literature whether age at the time of closed or open reduction and a specific surgical approach are associated with osteonecrosis. Better understanding of the impact of age at reduction and surgical approach is important to reduce the risk of osteonecrosis in patients with DDH.

Acetabuloplasties at Open Reduction Prevent Acetabular Dysplasia in Intentionally Delayed Developmental Dysplasia of the Hip: A Case-control Study

M. Belen Carsi MD, PhD, BSc, FRCS, Nicholas M. P. Clarke ChM, DM, FRCS

Avascular necrosis (AVN) and residual acetabular dysplasia are the two main complications of developmental dysplasia of the hip (DDH) treatment. Although early reduction of the hip may decrease the incidence of residual dysplasia, it may increase the incidence of AVN and vice versa. However, we do not know if changes in surgical technique may lead to a modification in these outcomes.

Have Changes in Treatment of Late-detected Developmental Dysplasia of the Hip During the Last Decades Led to Better Radiographic Outcome?

Terje Terjesen MD, PhD, Joachim Horn MD, PhD

Despite considerable changes in the treatment of of late-detected congenital or developmental hip dislocation (DDH) during the last 50 years, it is unclear whether and to what degree these changes have led to better long-term outcome for the patients.

How Does Bony Surgery Affect Results of Anterior Open Reduction in Walking-age Children With Developmental Hip Dysplasia?

Alpesh Kothari MRCS, MSc, George Grammatopoulos FRCS (Tr & Orth), DPhil, Sally Hopewell DPhil, Tim Theologis MSc, PhD

Anterior open reduction is commonly used to treat hip subluxation or dislocation in developmental dysplasia of the hip (DDH) in walking-age children. Pelvic and/or femoral osteotomy may be used in addition, but it is unclear how this affects avascular necrosis (AVN) risk and radiological and clinical results.

How Often Does Femoroacetabular Impingement Occur After an Innominate Osteotomy for Acetabular Dysplasia?

Pablo Castañeda MD, Carlos Vidal-Ruiz MD, Alfonso Méndez MD, Diego Pérez Salazar MD, Armando Torres MD, MSc, FACS

Femoroacetabular impingement is increasingly recognized as a cause of hip pain but its incidence after an innominate osteotomy for the correction of acetabular dysplasia has not been determined. This information would be essential for the orthopaedic surgeon because it has the potential to produce a poor outcome in the long term when trying to balance acetabular instability and overcorrection.

What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

George Grammatopoulos FRCS (Tr & Orth), DPhil, Jeremy Wales MBBS, Alpesh Kothari MSc, MRCS, Harinderjit S. Gill BEng, DPhil, Andrew Wainwright FRCS (Orth), MSc, Tim Theologis MSc, PhD, FRCS

The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described.

Implant-delivered Alendronate Causes a Dose-dependent Response on Net Bone Formation Around Porous Titanium Implants in Canines

Jenny Ann Pura MSc, J. Dennis Bobyn PhD, Michael Tanzer MD

Bony fixation of cementless orthopaedic implants is not always achieved, particularly in challenging scenarios such as revision surgery, trauma, and tumor reconstruction. An adjunct therapy for improving porous implant fixation could improve the reliability and durability of these reconstructive procedures.

Does Teriparatide Improve Femoral Neck Fracture Healing: Results From A Randomized Placebo-controlled Trial

Mohit Bhandari MD, PhD, Ling Jin MD, Kyoungah See PhD, Russel Burge PhD, Nigel Gilchrist MBChB, FRACP, Richard Witvrouw MD, Kelly D. Krohn MD, Margaret R. Warner PhD, DVM, Qasim I. Ahmad MD, Bruce Mitlak MD

There is a medical need for therapies that improve hip fracture healing. Teriparatide (Forteo/ Forsteo, recombinant human parathyroid hormone) is a bone anabolic drug that is approved for treatment of osteoporosis and glucocorticoid-induced osteoporosis in men and postmenopausal women at high fracture risk. Preclinical and preliminary clinical data also suggest that teriparatide may enhance bone healing.

Does Brachial Plexus Blockade Result in Improved Pain Scores After Distal Radius Fracture Fixation? A Randomized Trial

David K. Galos MD, David P. Taormina MD, Alexander Crespo MD, David Y. Ding MD, Anthony Sapienza MD, Sudheer Jain MD, Nirmal C. Tejwani MD

Distal radius fractures are very common injuries and surgical treatment for them can be painful. Achieving early pain control may help improve patient satisfaction and improve functional outcomes. Little is known about which anesthesia technique (general anesthesia versus brachial plexus blockade) is most beneficial for pain control after distal radius fixation which could significantly affect patients’ postoperative course and experience.

Greater Tuberosity Fractures: Does Fracture Assessment and Treatment Recommendation Vary Based on Imaging Modality?

Stein J. Janssen MD, Hugo H. Hermanussen BSc, Thierry G. Guitton MD, PhD, Michel P. J. Bekerom MD, Derek F. P. Deurzen MD, David Ring MD, PhD

For greater tuberosity fractures, 5-mm displacement is a commonly used threshold for recommending surgery; however, it is unclear if displacement can be assessed with this degree of precision and reliability using plain radiographs. It also is unclear if CT images provide additional information that might change decision making.

Is Arthroscopic Technique Superior to Open Reduction Internal Fixation in the Treatment of Isolated Displaced Greater Tuberosity Fractures?

Weixiong Liao PhD, Hao Zhang PhD, Zhongli Li PhD, Ji Li MD

Arthroscopic double-row suture-anchor fixation and open reduction and internal fixation (ORIF) are used to treat displaced greater tuberosity fractures, but there are few data that can help guide the surgeon in choosing between these approaches.

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Hoon Park MD, Keun Jung Ryu MD, Hyun Woo Kim MD, PhD, Jin Ho Hwang MD, PhD, Joon Woo Han MD, Dong Hoon Lee MD, PhD

During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone.

Does Sclerostin Depletion Stimulate Fracture Healing in a Mouse Model?

Mohammad M. Alzahrani MD, MSc, Frank Rauch MD, Reggie C. Hamdy MB, MSc(Ortho), FRCS(C)

Sclerostin is a secreted glycoprotein that inhibits the intracellular Wnt signaling pathway, which, when inactivated, stimulates bone formation. This has been seen in fracture studies, which have shown larger and stronger calluses with accelerated fracture healing in sclerostin knockout and sclerostin antibody injection models. However, the effects of these two mechanisms have not been compared in the context of fracture healing.

Reoperation After Cervical Disc Arthroplasty Versus Anterior Cervical Discectomy and Fusion: A Meta-analysis

Zhao-Ming Zhong MD, Shi-Yuan Zhu MS, Jing-Shen Zhuang MS, Qian Wu MD, Jian-Ting Chen MD

Anterior cervical discectomy and fusion is a standard surgical treatment for cervical radiculopathy and myelopathy, but reoperations sometimes are performed to treat complications of fusion such as pseudarthrosis and adjacent-segment degeneration. A cervical disc arthroplasty is designed to preserve motion and avoid the shortcomings of fusion. Available evidence suggests that a cervical disc arthroplasty can provide pain relief and functional improvements similar or superior to an anterior cervical discectomy and fusion. However, there is controversy regarding whether a cervical disc arthroplasty can reduce the frequency of reoperations.

Vascularized versus Nonvascularized Bone Grafts: What Is the Evidence?

Bradley J. Allsopp MBBS, David J. Hunter-Smith MBBS, Warren M. Rozen MBBS

There is a general perception in practice that a vascular supply should be used when large pieces of bone graft are used, particularly those greater than 6 cm in length for long-bone and large-joint reconstructions. However, the scientific source of this recommendation is not clear.

Catastrophic Femoral Neck Failure after THA with the Accolade® I Stem in Three Patients

Jonathon Spanyer MD, Jennifer Hines DO, Christopher Maxwell Beaumont BS, Jonathan Yerasimides MD

We report a series of three femoral stem failures, each occurring at the head-neck junction, with all patients experiencing limited and painful ambulation, leading to subsequent revision arthroplasty. All patients were male with high-offset femoral stems and increased head lengths, and each had undergone primary THA at a minimum of 7 years before presentation (average, 94 months). There were no associated deep infections or cases of aseptic loosening in the cohort.

Reply to the Letter to the Editor: Does Combined Intra- and Extraarticular ACL Reconstruction Improve Function and Stability? A Meta-analysis

Fernando Cury Rezende MD, Vinicius Ynoe Moraes MD, Marcus Vinícius Luzo PhD, Carlos Eduardo Silveira Franciozi MD, João Carlos Belloti PhD

Erratum to: Ceramic Heads Decrease Metal Release Caused by Head-taper Fretting and Corrosion

Sevi B. Kocagoz BS, Richard J. Underwood PhD, Daniel W. MacDonald MS, Jeremy L. Gilbert PhD, Steven M. Kurtz PhD
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