The Journal of Arthroplasty

Fifteen-Year to 19-Year Follow-Up of the Insall-Burstein-1 Total Knee Arthroplasty

Ayesha R. Abdeen, Stacy B. Collen, Kelly G. Vince — 2009-02-06

Abstract: This represents a 15-year to 19-year follow-up of 100 Insall-Burstein-I posterior-stabilized knee prostheses implanted in 86 patients from 1986 to 1989 and originally reported at 10 to 12 years (Thadani et al, 2000). In the original cohort, 6 failures occurred by 10 years. At 15 to 19 years, 55 patients (66 knees) had died; 18 patients were followed with clinical examination and radiographs, and 11 by telephone; 3 knees in 2 patients were lost. There were no new failures or additional surgeries from 10 to 19 years. Three knees exhibited osteolytic lesions. No case required revision due to symptomatic osteolysis or polyethylene wear. Using revision as end point, survival was 92.4% at 19 years. In summary, the prosthesis is likely to outlive the patients when classic indications for age and activity are respected.

Comparison of Simultaneous Bilateral and Staged Bilateral Total Knee Arthroplasty in Terms of Perioperative Complications

Hang-Seob Yoon, Chang-Dong Han, Ick-Hwan Yang — 2009-02-05

Abstract: We compared bilateral total knee arthroplasty (TKA) performed at a single session vs those performed at 2 separate sessions with respect to complications, amount of blood loss, and length of hospital stay. Study participants included 119 consecutive patients undergoing simultaneous bilateral TKA and an additional 119 patients undergoing staged bilateral TKA. Systemic complication in the simultaneous bilateral TKA was significantly higher statistically than that in the staged bilateral TKA. Therefore, performing simultaneous bilateral TKA in elderly or high-risk patients results in a significantly higher rate of systemic complications. Simultaneous bilateral TKA is a relatively safe and beneficial procedure with a minimal increase in the risk of systemic complications. However, this procedure should be conducted carefully, particularly in elderly and high-risk patients.

Successful Performance of the Bi-Metric Uncemented Femoral Stem at a Minimum Follow-Up of 13 Years in Young Patients

Howard Davies, Ben Ollivere, Joseph Motha, Matthew Porteous, Adrian August — 2009-02-05

Abstract: We report the mean 15.2 year follow-up results for a porous coated version of the Bi-Metric (Biomet UK Ltd, Bridgend, UK) uncemented femoral stem in young patients. Sixty-four hips were implanted into 54 patients (mean age, 54.3 years) and followed up using the Hospital for Special Surgery score and regular radiographs. The first 13 patients had a TTAP-ST acetabulum (Biomet UK), the remainder receiving a Universal cup (Biomet UK). At 15.2 years, there were no stem failures or femoral revisions. The mean Hospital for Special Surgery score was 34.7 (20-40), and there was no evidence of stem loosening radiologically. There were 3 acetabular revisions and 3 liner changes at 10 years, with a further 5 cup revisions and 9 liner changes at final follow-up.

The Cost-effectiveness of Routine Follow-up After Primary Total Hip Arthroplasty

2009-02-05

Abstract: Routine postsurgery assessment of primary total hip arthroplasty (THA) is recommended in many countries. Whether the benefits of this activity are justified by the costs is not known. We used a decision-analytic Markov model to compare the costs and health outcomes of 3 different follow-up strategies after primary THA. If there is no routine follow-up of patients for 7 years after primary THA, there would be cost savings between AU$6.5 and $11.9 million and gains of between 1.8 and 8.8 quality-adjusted life years. Policy makers should investigate less resource-intensive alternatives to common routine postsurgical assessment.

Acetabular Cup Revision With the Use of the Medial Protrusio Technique at an Average Follow-up of 6.6 Years

David Fabi, Mark Gonzalez, Wayne Goldstein, Muhammad Ahmed — 2009-05-13

Abstract: A significant rim defect encountered during revision surgery can make stable cementless cup fixation difficult. One approach to this problem is to medialize the acetabular cup to improve the degree of rim contact. In this study, we investigate this technique, termed the medial protrusio technique, for acetabular fixation in revision hip arthroplasty. A retrospective review of 25 patients (25 hips) who underwent medialization was performed. Clinical and radiographic evaluation was performed. At an average follow-up of 6.6 years, the overall patient function and satisfaction were good to excellent, with a mean Harris hip score of 85.2. This demonstrates that the medial protrusio technique can be a valuable option in addressing acetabular cup failure.

Hylamer vs Conventional Polyethylene in Primary Total Hip Arthroplasty: A Long-Term Case-Control Study of Wear Rates and Osteolysis

James I. Huddleston, Alex H.S. Harris, Cesar A. Atienza, Steven T. Woolson — 2009-03-06

Abstract: The long-term results of Hylamer implants have not been reported previously. Clinical and radiographic results of a consecutive series of 43 patients (45 hips) who had primary total hip arthroplasty using Hylamer liners were compared with those of 37 patients (43 hips) who had conventional liners after 10-year follow-up. The linear wear rates for Hylamer and conventional polyethylene acetabular liners were 0.21 and 0.20 mm/y, respectively. The number of pelvic osteolytic lesions and their size detected on plain radiographs were significantly greater for Hylamer liners. Seven Hylamer hips were revised or are pending revision for osteolysis (16%) compared with 1 control hip. Close radiographic surveillance of patients who have Hylamer liners and evidence of osteolysis found on plain radiographs is warranted.

Trochanteric Bursitis After Total Hip Arthroplasty: Incidence and Evaluation of Response to Treatment

2009-03-05

Abstract: We examined the efficacy of corticosteroid injection as treatment for postarthroplasty trochanteric bursitis and the risk factors for failure of nonoperative treatment. There were 32 (4.6%) cases of postsurgical trochanteric bursitis in 689 primary total hip arthroplasties. Of the 25 hips with follow-up, 11 (45%) required multiple injections. Symptoms resolved in 20 (80%) but persisted in 5. We found no statistically significant differences between patients who did and did not develop trochanteric bursitis, or between those who did and did not respond to treatment. There was a trend toward younger age and greater limb-length discrepancy in nonresponders. In conclusion, (1) corticosteroid injection(s) for postoperative trochanteric bursitis is effective; and (2) nonoperative management may be more likely to fail in young patients and those with leg-length discrepancy.

Using VistA Electronic Medical Record Data Extracts to Calculate the Waiting Time for Total Knee Arthroplasty

Tamseela Hussain, Brian Bell, Cynthia Brandt, Jessica Nuzzo, Joseph J. Erdos — 2009-12-21

Abstract: This is a retrospective database study of veterans who had total knee arthroplasty (TKA) at Veterans Affairs Connecticut Healthcare System. The objective of this study is to determine if VistA medical records data can be used to create a methodology for accurate assessment of waiting times for TKAs performed at Veterans Affairs facilities. The average waiting period from date of “initial consult” to date TKA was performed was greater than two years. The average waiting period from “most recent consult” to TKA was less than a year. This new approach and methodology has great impact as it provides an electronic method for calculating the TKA wait time which is broadly generalizable for similar analysis at the VISN (Veteran Integrated Services Network) or regional level.

An Arthroscopic Technique to Enhance Visualization During Total Hip Arthroplasty

2009-02-06

Abstract: This technical note describes the use of an arthroscope or endoscope to enhance visualization during minimally invasive total hip arthroplasty. The arthroscope/endoscope is used to verify seating of the components and to look for potential impingements, loose bodies, or fractures. This technique was successfully used to identify and address 2 bony or soft tissue impingements as well as a calcar fracture that might otherwise have been missed. Although further study is necessary, we believe that this technique might reduce postoperative complications and improve clinical outcomes of total hip arthroplasty.

Achieving Deep Flexion After Primary Total Knee Arthroplasty

Samih Tarabichi, Yasir Tarabichi, Marwan Hawari — 2008-12-24

Abstract: Total knee arthroplasty patients often have difficulty performing activities involving flexion beyond 130°. The NexGen LPS Flex (Zimmer Inc, Warsaw, Ind) mobile bearing implant accommodates up to 155° of flexion. Two hundred eighteen total knee arthroplasties were performed using this implant on 125 patients over a 2-year period with a minimum of 5 years follow-up. All data were collected prospectively. Forty-four percent of preoperative cases had full flexion (ie, 140° active flexion and ability to kneel with thigh/calf contact for 1 minute). Five-year data showed an average flexion of 140° ± 11.5° and flexion greater than 140° in 103 knees (68%). There were no differences in patellofemoral pain levels, complications, or Knee Society scores despite our patients having, on average, an increase in flexion and function.

Extension Limitation in Standing Affects Weight-Bearing Asymmetry After Unilateral Total Knee Arthroplasty

2009-03-06

Abstract: The aim of this study was to evaluate weight-bearing condition after unilateral total knee arthroplasty (TKA) during standing and to examine whether the condition affects knee kinetics during gait in both limbs. Twenty-five patients, who underwent unilateral TKA for symptomatic bilateral osteoarthritis and who were on average 74 years old, participated. As a result, operated limbs became dominant in 80% of the patients. The other 20%, who had lack of knee extension during standing, showed more weight bearing in nonoperated knees. Furthermore, extension limitation in the operated knee in standing led to mechanical overload in the contralateral limb during gait. Therefore, to avoid progression of the osteoarthritis in the contralateral knee, it is important to acquire full extension in the operated knees during standing after unilateral TKA.

Robot-Assisted Unicompartmental Knee Arthroplasty

Andrew D. Pearle, Padhraig F. O'Loughlin, Daniel O. Kendoff — 2008-12-05

Abstract: The outcomes of unicompartmental knee arthroplasties (UKAs) have demonstrated inconsistent long-term survival. We report the first clinical series of UKA using a semiactive robotic system for the implantation of an inlay unicondylar knee arthroplasty. Ten patients were selected for this study. Preoperative mechanical leg alignment values ranged from 0.3° varus to 9.8° varus. A haptic guidance system was used; a detailed description is given in the manuscript. The setup time for the robot was 41 minutes; intraoperative registration process, 7.5 minutes (6-13 minutes); skin incision, 8 cm; robot-assisted burring, 34.8 minutes (18-50 minutes); mean tourniquet time, 87.4 minutes (68-113 minutes); and overall operation time, 132 minutes (118-152 minutes). The planned and intraoperative tibiofemoral angle was within 1°. The postoperative long leg axis radiographs were within 1.6°. Haptic guidance in combination with a navigation module allows for precise planning and execution of both inlay components in UKA.

Variability in Femoral Component Rotation Reference Axes Measured During Navigation-Assisted Total Knee Arthroplasty Using Gap Technique

Young-Wan Moon, Jai-Gon Seo, Seung-Jae Lim, Jae-Hyuk Yang — 2009-06-26

Abstract: The basic objective in total knee arthroplasty is to achieve the correct amount of femoral component rotation, and this can be achieved either with a measured resection technique or indirectly with a flexion/extension gap equalization technique. We studied variability in the reference axes (posterior condylar axis, Whiteside's line, transepicondylar axis) when soft tissue tension was managed intraoperatively using a navigation system. The mean angles for the transepicondylar line, Whiteside's line, and the posterior condylar line from the proximal tibia resection plane were 1.29° ± 3.67° (mean ± SD; range, −7° to 10.5°), 3.90° ± 4.17° (mean ± SD; range, −3° to 15.5°), and −4.03° ± 2.71° (mean ± SD; range, −9.5° to 1.0°), respectively. The coefficients of variation (SD/mean ×100) for these 3 variables were 283%, 106%, and 67%, respectively. Of the 3 reference axes used widely for femoral component rotation, the angles from the posterior condylar line to the proximal tibia resection plane showed the smallest range of variance.

Comparison of Drainage Techniques on Prolonged Serous Drainage after Total Hip Arthroplasty

Andrej Strahovnik, Samo K. Fokter, Marko Kotnik — 2008-12-05

Abstract: The aims of this study were to determine (1) whether the duration of closed suction drainage affects the occurrence and duration of prolonged serous drainage and (2) if closed suction drains could be omitted according to the wound and/or thigh appearance after unilateral primary total hip arthroplasty. One hundred thirty-nine patients undergoing total hip arthroplasty were randomized into 3 groups: 42 patients received no drainage, 46 patients received drainage for 24 hours, and 51 patients received drainage for 48 hours. No differences with respect to occurrence and duration of prolonged serous drainage were found between the 2 groups with drains. Although no prolonged serous drainage occurred, the swelling of the thigh was significantly greater (P < .001) and the occurrence of prolonged thigh pain was significantly higher (P = .01) in the group without drainage.

Gull-Wing Osteotomy for the Treatment of the Deficient Patella in Revision Total Knee Arthroplasty

2009-02-05

Abstract: Reconstruction of the deficient patella remains a challenge in revision total knee arthroplasty. Twelve consecutive patients who had a knee revision in which a nonresurfacable patella was treated with a gull-wing patellar osteotomy were followed using a computerized database. Radiographs revealed successful healing of the osteotomy in all patients with central tracking of the patella in the trochlear groove. There was a significant improvement in the range of motion and Knee Society scores. There were no patellar fractures or significant patellar malalignment in this series. This technique has shown promising results for the treatment of the nonresurfacable patella during revision total knee arthroplasty, and we conclude that it is a viable method of patellar salvage reserved for the most advanced cases of patellar bone stock compromise.

Using Hierarchical Linear Modeling to Explore Predictors of Pain After Total Hip and Knee Arthroplasty as a Consequence of Osteoarthritis

Ashley Halket, Paul W. Stratford, Deborah M. Kennedy, Linda J. Woodhouse — 2009-07-22

Abstract: Hierarchical linear modeling was used to establish differences in, and the average pattern of, recovery of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 2 composite performance-specific measures of pain as well as to determine if significant individual variations exist in the growth curves for each measure. Predictors of postoperative pain were also of interest. One hundred forty-seven patients undergoing unilateral primary hip or knee arthroplasty completed 4 performance measures—self-paced 40-m walk, timed up and go, stair test, and 6-minute walk—and the WOMAC prearthroplasty and at multiple points in time between 2 and 27 weeks postarthroplasty. Although patients reported different levels of postoperative pain initially, similar recovery patterns were noted. Predictive variables were found to be site of joint arthroplasty and WOMAC prearthroplasty pain scores for the WOMAC pain subscale, the site of joint arthroplasty and sex for the first composite pain score, and sex for the second composite.

Minimal Radiation Dose Computed Tomography for Measurement of Cup Orientation in Total Hip Arthroplasty

Noriyuki Arai, Shigeru Nakamura, Takashi Matsushita, Shigeru Suzuki — 2009-05-13

Abstract: We studied a computed tomography (CT) protocol with minimal radiation dose for measurements of cup orientation after total hip arthroplasty. Inclination and version angles were measured directly on cadaver pelvis fixed with an acetabular component. We performed the CT scanning on the phantom made of this model in 6 protocols as follows: tube current of 300, 100, 50, 30, 20, and 10 mA. The 30 mA protocol maintained good image quality for measurements with the smallest dose (1.1 millisievert), which corresponds to less than 2 times that of an anteroposterior radiograph of the pelvis. The differences of measured angles between direct and CT measurements on the phantom were less than 1°. Measurements of cup orientation were possible by this protocol in 26 hips in 22 patients after total hip arthroplasty.

Use of a New High-Activity Arthroplasty Score to Assess Function of Young Patients With Total Hip or Knee Arthroplasty

Simon Talbot, Gary Hooper, Andrew Stokes, Rachel Zordan — 2008-12-04

Abstract: The High-Activity Arthroplasty Score (HAAS) was specifically developed to assess subtle variations in functional ability after lower limb arthroplasty with particular regard to highly functioning individuals. The score was a 4-item self-assessment measure covering the 4 domains of walking, running, stair climbing, and general activities, with a possible score ranging from 0 to 18 points. The score was validated in 22 patients (total hip arthroplasty [THA], n = 11; total knee arthroplasty [TKA], n = 11) by comparison with the Oxford, Knee Society, Harris Hip, and Short WOMAC scores. The HAAS was then administered to 152 high-functioning arthroplasty patients (THA, n = 99; TKA, n = 53), all younger than 66 years. The HAAS produced a much wider range of scores, allowing greater differentiation of level of function between patients in assessing performance after TKA or THA.

Isokinetic Strength Testing of Minimally Invasive Total Knee Arthroplasty Recovery

William C. Schroer, Paul J. Diesfeld, Mary E. Reedy, Angela R. LeMarr — 2008-12-08

Abstract: Fifty patients underwent isokinetic muscle strength testing before surgery and at 6 weeks, 3 months, 6 months, and 1 year after unilateral total knee arthroplasty using the minisubvastus surgical technique. Quadriceps muscle strength returned to preoperative levels by 3 months postoperatively and was 17% stronger at 6 months and 30% stronger at 1 year than preoperative levels (P < .05). At 1 year, the quadriceps strength of the involved knee was equivalent to that of the uninvolved knee (P = .81). When the entire study population was subdivided by age, weight, sex, and the presence of arthritis in the uninvolved knee, each subgroup still had equivalent quadriceps strength between the involved and uninvolved knees. This prospective study demonstrated that the minisubvastus total knee arthroplasty technique led to a more rapid and more complete recovery of muscle strength than has been previously demonstrated after total knee arthroplasty with a medial parapatellar arthrotomy.

Interprosthetic Fractures of the Femur: Treatment With a Single-Locked Plate

2008-12-04

Abstract: Interprosthetic fractures of the femur, those between an ipsilateral hip and knee arthroplasty, are challenging to treat secondary to limited bone available for fixation, osteopenic bone, a compromised intramedullary blood supply, and an often elderly patient population. From 2002 to 2006, 22 consecutive patients with an interprosthetic femur fracture were treated with a single-locking plate. Follow-up averaged 17.7 months, with fracture union achieved an average of 13.8 weeks postoperatively. All patients regained their preoperative ambulatory status and subjectively reported unchanged function of their hip and knee arthroplasties. Single-locked plating is an effective method of treatment of interprosthetic fractures of the femur. Emphasis on preservation of the soft tissue envelope and sufficient cortical purchase both above and below the fracture is of paramount importance.

Complications Encountered With the Use of Constrained Acetabular Prostheses in Total Hip Arthroplasty

Christophe Pattyn, Roel De Haan, Alex Kloeck, Georges Van Maele, Koen De Smet — 2008-12-05

Abstract: At our department, 46 constrained acetabular components in 38 patients were placed successively for a period of 4 years. Indications included recurrent dislocation, septic and aseptic loosening with extensive bone loss, tumor surgery with extensive bone resection, and instability due to neurologic impairment. Because 2 cup failures and 10 dislocations were observed with the constrained devices at 4 to 7 years of follow-up, the authors started to use large-diameter metal-on-metal bearings for similar indications. A series of 36 such bearings in 38 patients revealed only one cup failure and one dislocation at 2 to 4 years of follow-up. Although the 2 series are different and therefore difficult to compare, the authors recommend judicious use of constrained devices because of the high failure rate (26%) and consideration of alternative options such as the use of large-diameter metal-on-metal bearings.

Total Knee Arthroplasty for Arthritic Knees with Tibiofibular Stress Fractures: Classification and Treatment Guidelines

Arun Mullaji, Gautam Shetty — 2008-12-24

Abstract: Forty-two tibial and 5 fibular stress fractures in 34 patients with knee arthritis were radiologically classified into intraarticular malunited and ununited fractures, and extraarticular impending, acute, united, malunited, and ununited fractures. Depending on fracture type, total knee arthroplasty was performed using long-stem tibial component, metal augments, corrective osteotomy, or in routine fashion. At a mean follow-up of 36 months, the mean Knee Society knee score improved from 36.7 points preoperatively to 90.3 points; function score improved from 24 to 86.2 points. All fractures had united at the last follow-up with no complications of infection, joint instability, and patellar problems. Total knee arthroplasty for knee arthritis in the presence of tibiofibular stress fractures restores limb alignment and facilitates fracture healing with excellent functional outcome.

In Vivo Femoral Head Damage and Its Effect on Polyethylene Wear

2009-02-09

Abstract: The purposes of this study were to determine the spectrum of femoral head damage in patients undergoing revision total hip arthroplasty and to determine the impact of that damage on polyethylene wear. One hundred eight consecutive modular metal femoral heads were retrieved at revision surgery. The mean roughness (Ra) value was 0.18 ± 0.18 μm. The roughest femoral heads (mean Ra, 0.56 μm) were from retrievals correlated with mode 2 wear (recurrent dislocation and complete wear through of the polyethylene liner). Five million cycles of wear tests were performed using retrieved femoral heads against both new conventional and highly cross-linked polyethylene. The mean wear rate of conventional polyethylene was 15.9 ± 4.3 mg and that of highly cross-linked polyethylene was 0.04 ± 0.14 mg per 1 million cycles (P < .001). Highly cross-linked polyethylene was more resistant to wear than conventional polyethylene, even when mated against roughened femoral heads.

Cementless Acetabular Fixation With and Without Screws: Analysis of Stability and Migration

2009-03-23

Abstract: The purpose of this study was to compare initial stability and late migration of 775 cementless acetabular components with and without screw fixation. Screw fixation was used in 509 cups and no screws in 266 cups. Average follow-up in the screw fixation group was 6.32 years (range, 2-10 years) and 6.9 years (range, 2-10 years) in the no-screw group. One component (0.2%, osteolysis) in the screw group and one (0.4%, loss of fixation) in the no-screw group required revision. Osteolytic lesions more than 4 cm2 were noted in 8 (1.6%) screw fixation cups and 2 (0.75%) no-screw fixation cups. No cups in either cohort had radiographic evidence of migration. Screw fixation did not have a favorable or adverse effect on the outcome of acetabular reconstruction.

The Effects of Bone Resection Depth and Malalignment on Strain in the Proximal Tibia After Total Knee Arthroplasty

Michael E. Berend, Scott R. Small, Merrill A. Ritter, Christine A. Buckley — 2009-04-06

Abstract: The clinical significance of tibial resection depth in total knee arthroplasty (TKA) is not clearly understood. The purpose of this study was to quantify the effect of tibial resection depth in TKA on tibial loading. Tibiae were coated with a photoelastic resin enabling full-field dynamic shear strain quantification in the tibial metaphysis during TKA loading. A standard resection level (5 mm) was compared to a resection level 15 mm distal to the joint line. Both had appropriate-sized tibial components. With 15 mm of tibial resection, strains increased up to 281% in the proximal and peripheral regions of the tibia during neutral loading and up to 315% anteriorly and 197% peripherally during varus loading. Distal resection levels result in significant smaller component size and relatively posterior and peripheral displacement of the implant. Changes in loading patterns in specimens with increased tibial resection depths have not previously been described.

An Improved Method for Cable Grip Fixation of the Greater Trochanter After Trochanteric Slide Osteotomy

2008-12-08

Abstract: This study proposes a novel method for reattachment of the trochanteric slide osteotomy. The strength of this new fixation system was compared to established configurations. Fifteen sawbone femurs were used. Our configuration used cables above and below the lesser trochanter with a third cable around the shaft of the femur while passing the loose ends through the inferior hole of the cable grip. Displacement of the trochanter was measured with increasing load. Force required for catastrophic failure was also measured. The 3-cable construct resulted in significantly less displacement with increasing load and required a larger force to cause failure (1 cm and 2 cm). We theorize that our configuration produces a biomechanically stronger construct than previously used methods.

Comparison of Bone Removed During Total Hip Arthroplasty With a Resurfacing or Conventional Femoral Component: A Cadaveric Study

Edwin P. Su, Michael Sheehan, Sherwin L. Su — 2008-12-04

Abstract: We sought to examine the amount of bone removed during total hip arthroplasty with a resurfacing femoral component, compared to with a conventional, stemmed femoral component, by using 6 male and 4 female cadaveric pelves with attached bilateral proximal femora. Using randomized assignment and order, a total hip arthroplasty with a resurfacing femoral implant was performed on one side, and total hip arthroplasty with a cementless, stemmed femoral implant was performed on the contralateral side. The relationship between native femoral head diameter and the implanted acetabular socket was on average within 2 mm for both procedures. No significant difference was observed in the amount of acetabular bone removed (9.8 g for hip resurfacing vs 8.8 g). However, a resurfacing component resulted in approximated 3 × less bone removal from the femur (25.8 g vs 75.1 g). This study shows that the preservation of femoral bone with a resurfacing femoral component does not result in an increased removal of acetabular bone when compared to the use of a conventional, stemmed femoral component.

Three-Dimensional Surface Deviation Maps for Analysis of Retrieved Polyethylene Acetabular Liners Using Micro-Computed Tomography

Matthew G. Teeter, Douglas D.R. Naudie, Kory D. Charron, David W. Holdsworth — 2009-12-21

Abstract: Micro-computed tomography (micro-CT) has previously been validated for measuring wear volume in polyethylene acetabular liners. The creation of 3-dimensional (3D) articular and backside surface deviation maps using micro-CT is described. An acetabular liner was retrieved after 16.7 years of implantation and scanned with micro-CT along with a new, never-implanted liner of the same size and type. The liner surface geometries were reconstructed and co-aligned. A 3D comparison and cross-sectional analysis was performed. Maximum 3D deviation of the articular surface was −2.48 ± 0.02 mm, with maximum backside deviation of 0.46 ± 0.02 mm. Micro-CT can measure surface deviation and therefore calculate the volume of wear plus creep of retrieved acetabular liners, and may be applicable for wear simulator studies and analyzing other polyethylene components including tibial inserts.

Early Failure of a Nonmodular Titanium Femoral Stem After Primary Hip Arthroplasty

Khalid A. Azzam, Matthew S. Austin, Peter F. Sharkey — 2009-01-16

Abstract: Fully porous-coated cementless implants have a low failure rate and excellent survivorship in primary and revision surgery. Failure secondary to implant fracture is extremely rare with modern implant designs. We report an early fracture of a fully porous-coated femoral stem after primary total hip arthroplasty. The implant failed because of a filling mismatch between the proximal and distal femur.

Lateral Meniscal Injury After a Successful Medial Unicompartmental Knee Arthroplasty

Marlon M. Mencia, Mark J. Ashworth — 2009-02-23

Abstract: A case of an active 52-year-old woman who, after a medial unicompartmental knee arthroplasty, began complaining of lateral joint line pain and a persistent knee effusion. A lateral meniscal tear was diagnosed clinically, and she underwent an arthroscopic partial meniscectomy that resolved her problems. This case demonstrates the importance of considering a meniscal problem as the cause of any unexplained joint line pain in the unoperated compartment after a successful unicompartmental knee arthroplasty and not simply attributing it to progression of degenerative change within the lateral compartment.

Pigmented Villonodular Synovitis of the Hip Presenting as a Buttock Mass Treated by Total Hip Arthroplasty

Kyung Soon Park, Sanket R. Diwanji, Hyun Kee Yang, Taek Rim Yoon, Jong Keun Seon — 2008-12-05

Abstract: Pigmented villonodular synovitis (PVNS) of the hip is a relatively uncommon benign but locally aggressive disease that should be considered in younger patients presenting with monoarticular joint symptoms. Pigmented villonodular synovitis begins in and usually remains confined within a synovium-lined joint, but rarely, it may extend beyond the joint capsule and present as a soft tissue mass. The authors report a previously unrecognized presentation of PVNS of the hip in a 36-year-old man, who presented with a buttock mass arising from the right hip joint. The patient was treated by synovectomy and total hip arthroplasty.

Computer Navigation and Fixator-Assisted Femoral Osteotomy for Correction of Malunion After Periprosthetic Femur Fracture

2009-01-16

Abstract: Periprosthetic femoral fracture post–total knee arthroplasty can lead to malunion. This may lead to abnormal force transmission and accelerated wear of the prosthesis. Accurate femoral deformity correction depends on the combined correction of the mechanical axis alignment and the lateral distal femoral angle. Modern external fixation correction devices allow for simultaneous gradual corrections in multiple planes through one osteotomy site. Despite the accuracy of the devices, technical failures occur and are typically due to difficulty in assessing the exact intraoperative correction. Furthermore, conventional intraoperative measurements display high interobserver and intraobserver variations. Computer navigation has demonstrated great accuracy. Combining a mechanical corrective device and navigation should allow for increased precision and dynamic control intraoperatively. The current authors report on a clinical application of a novel minimally invasive fixator-assisted correction of a posttraumatic distal femoral varus deformity after total knee arthroplasty with combined navigated measurements.

Late Transection of the Sciatic Nerve in Association With an Acetabular Reconstruction Cage

Luke Gauthier, David Allen, Paul Kim — 2008-12-05

Abstract: We report a case of a late-onset sciatic nerve palsy that occurred in association with an acetabular reconstruction cage. On surgical exploration, the nerve was found to be completely transected secondary to abrasion over the posterior flange of the reconstruction cage.

Internal Fixation After Subtrochanteric Femoral Fracture After Hip Resurfacing Arthroplasty

2008-12-05

Abstract: Periprosthetic fractures around total hip arthroplasty create surgical challenges with many described techniques of either fixation or revision. The increasing popularity of hip resurfacing arthroplasty poses different problems especially if there is a desire to retain the prosthesis rather than converting to a total hip arthroplasty. We describe a previously unreported technique of fixation for a comminuted, proximal femoral fracture, beneath a hip resurfacing.

Disassembly of a Distal Femur Modular Prosthesis After Tumor Resection

Olimpio Galasso, Massimo Mariconda, Antonio Brando, Bruno Iannò — 2008-12-05

Abstract: We report and analyze the causes of a disassembly of a newly marketed distal femur modular prosthesis in a 20-year-old man with stage IIB osteosarcoma. The disassembly occurred after discharge from the hospital, after a minor trauma. Because of the unique displacement of the femoral component, sudden operative management was performed. Disassembly should be considered as a potential complication when choosing a modular prosthesis despite improvements in the design of some recent devices. In cases with a substantial amount of functional muscle excised at the time of tumor resection, adequate postoperative rehabilitation is recommended.

Infection or Allergy in the Painful Metal-on-Metal Total Hip Arthroplasty?

Leela C. Biant, Warwick J.M. Bruce, Hans van der Wall, William R. Walsh — 2009-02-25

Abstract: Metal-on-metal articulations are increasingly used in total hip arthroplasty. Patients can be sensitive to metal ions produced by the articulation and present with pain or early loosening. Infection must be excluded. Correct diagnosis before revision surgery is crucial to implant selection and operation planning. There is no practical guide in the literature on how to differentiate between allergy and infection in a painful total hip arthroplasty. We present the history, clinical findings and hip scores, radiology, serology, hip arthroscopy and aspirate results, labeled white cell scan, revision-hip findings, histology and clinical results of a typical patient with a hypersensitivity response to a metal-on-metal hip articulation, and how results differ from patients with an infected implant. A practical scheme to investigate patients with a possible hypersensitivity response to an implant is presented.

Andrea Emilio Salvi — 2009-09-24

I have read with great interest the article from Kindsfater et al . In the Discussion, the authors declare to have found 2 reports in the literature relating the treatment of chronically dislocated total hip arthroplasty. It is my purpose to briefly describe another similar report in which the dislocation was treated with a different surgical management. An elder woman (year of birth: 1919) was operated on in 1989 with a cemented total hip prosthesis. In 1994, she underwent a clinical and radiologic examination that confirmed the right allocation of both the cup and stem. In a period between 1994 and 2002, the patient, who does not bear in mind the year of the episode, fell from her bicycle and had an injury on the prosthetized hip, but she did not want to attend to any emergency department. In 2002, because of experiencing pain while walking and also overnight when she lay on the operated hip side, she was visited at our Orthopaedic Department. X-rays showed cemented acetabular polyethylene cup rotation with formation of a pseudoacetabulum superiorly and laterally to the prosthetic cup due to the grinding action of the metal ball on the bone. Considered that the socket was stable at the intraoperative evaluation and because of its position, at danger for possible neurovascular lesions if removed, it was left in place, and a second cemented polyethylene cup was positioned alongside with proper tilt and anteversion , using the primary rotated cup as a as a stable support “wall” in DeLee and Charnley zone 3 , a radiological hip sector particularly subjected to harmful tensile forces that may cause loosening of the primary cups. The cemented prosthetic stem was removed and a new uncemented one was implanted. Patient, visited in July 2007, weight-bears the operated hip without ache.

In Reply:

Kirk A. Kindsfater — 2009-09-24

Dr Salvi reports on a case similar to our published case report. This case was different in that Dr Salvi's patient had pain, and therefore, surgical intervention appeared necessary. Our patient was pain-free, and therefore, surgical intervention was deferred. It would be interesting to see this x-ray with 2 acetabular cups in place. As long as there is no prosthetic impingement on the retained malpositioned cup, this seem to be a reasonable treatment in this elderly, low-demand patient if the risks of removing the malpositioned component outweigh the benefits.

Editorial Board

2010-02-01

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2010-02-01

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2010-02-01

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2010-02-01

The Journal of Arthroplasty

Fifteen-Year to 19-Year Follow-Up of the Insall-Burstein-1 Total Knee Arthroplasty

Comparison of Simultaneous Bilateral and Staged Bilateral Total Knee Arthroplasty in Terms of Perioperative Complications

Successful Performance of the Bi-Metric Uncemented Femoral Stem at a Minimum Follow-Up of 13 Years in Young Patients

The Cost-effectiveness of Routine Follow-up After Primary Total Hip Arthroplasty

Acetabular Cup Revision With the Use of the Medial Protrusio Technique at an Average Follow-up of 6.6 Years

Hylamer vs Conventional Polyethylene in Primary Total Hip Arthroplasty: A Long-Term Case-Control Study of Wear Rates and Osteolysis

Trochanteric Bursitis After Total Hip Arthroplasty: Incidence and Evaluation of Response to Treatment

Using VistA Electronic Medical Record Data Extracts to Calculate the Waiting Time for Total Knee Arthroplasty

An Arthroscopic Technique to Enhance Visualization During Total Hip Arthroplasty

Achieving Deep Flexion After Primary Total Knee Arthroplasty

Extension Limitation in Standing Affects Weight-Bearing Asymmetry After Unilateral Total Knee Arthroplasty

Robot-Assisted Unicompartmental Knee Arthroplasty

Variability in Femoral Component Rotation Reference Axes Measured During Navigation-Assisted Total Knee Arthroplasty Using Gap Technique

Comparison of Drainage Techniques on Prolonged Serous Drainage after Total Hip Arthroplasty

Gull-Wing Osteotomy for the Treatment of the Deficient Patella in Revision Total Knee Arthroplasty

Using Hierarchical Linear Modeling to Explore Predictors of Pain After Total Hip and Knee Arthroplasty as a Consequence of Osteoarthritis

Minimal Radiation Dose Computed Tomography for Measurement of Cup Orientation in Total Hip Arthroplasty

Use of a New High-Activity Arthroplasty Score to Assess Function of Young Patients With Total Hip or Knee Arthroplasty

Isokinetic Strength Testing of Minimally Invasive Total Knee Arthroplasty Recovery

Interprosthetic Fractures of the Femur: Treatment With a Single-Locked Plate

Complications Encountered With the Use of Constrained Acetabular Prostheses in Total Hip Arthroplasty

Total Knee Arthroplasty for Arthritic Knees with Tibiofibular Stress Fractures: Classification and Treatment Guidelines

In Vivo Femoral Head Damage and Its Effect on Polyethylene Wear

Cementless Acetabular Fixation With and Without Screws: Analysis of Stability and Migration

The Effects of Bone Resection Depth and Malalignment on Strain in the Proximal Tibia After Total Knee Arthroplasty

An Improved Method for Cable Grip Fixation of the Greater Trochanter After Trochanteric Slide Osteotomy

Comparison of Bone Removed During Total Hip Arthroplasty With a Resurfacing or Conventional Femoral Component: A Cadaveric Study

Three-Dimensional Surface Deviation Maps for Analysis of Retrieved Polyethylene Acetabular Liners Using Micro-Computed Tomography

Early Failure of a Nonmodular Titanium Femoral Stem After Primary Hip Arthroplasty

Lateral Meniscal Injury After a Successful Medial Unicompartmental Knee Arthroplasty

Pigmented Villonodular Synovitis of the Hip Presenting as a Buttock Mass Treated by Total Hip Arthroplasty

Computer Navigation and Fixator-Assisted Femoral Osteotomy for Correction of Malunion After Periprosthetic Femur Fracture

Late Transection of the Sciatic Nerve in Association With an Acetabular Reconstruction Cage

Internal Fixation After Subtrochanteric Femoral Fracture After Hip Resurfacing Arthroplasty

Disassembly of a Distal Femur Modular Prosthesis After Tumor Resection

Infection or Allergy in the Painful Metal-on-Metal Total Hip Arthroplasty?

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