Anterior capsulectomy versus repair in direct anterior total hip arthroplasty.

Background: Utilization of the direct anterior approach for total hip arthroplasty (DAA THA) has increased over the last ten years. The preservation and repair of the anterior hip capsule has been recommended, while anterior capsulectomy has been described by others. In contrast, the higher risk of posterior dislocation using the posterior approach improved significantly after capsular repair.

Total Hip Arthroplasty in Patients With Severe Chronic Pubic Diastasis.

Background: Total hip arthroplasty (THA) in patients with severe chronic pubic diastasis from either congenital or acquired causes presents an exceptionally difficult challenge that has rarely been addressed in the arthroplasty literature. The purpose of this paper is to present a series of THAs in patients with severe chronic pubic diastasis, asking the following research questions: (1) What is the survivorship and clinical outcomes after THA in patients with severe chronic pubic diastasis? And (2) What is the rate of complications after THA surgery in this challenging patient population? We additionally describe our algorithm for preoperative planning and rationale for surgical technique and implant position.

Material And Methods: We retrospectively queried the prospective arthroplasty database of 2 high-volume referral centers, yielding 6 THA in 4 patients with severe chronic pubic diastasis (minimum 8 cm) with a mean follow-up of 2.

Results of the First U.S. FDA-Approved Hip Resurfacing Device at 10-Year Follow-up.

Background: The BIRMINGHAM HIP Resurfacing (BHR) system is a metal-on-metal hip implant system approved by the U.S. Food and Drug Administration in 2006.

Acetabular Exposure Is Enhanced With Self-Retaining Retractors During Direct Anterior Total Hip Arthroplasty.

Acetabular exposure for direct anterior (DA) total hip arthroplasty (THA) can be performed using hands-free, self-retaining retractors. No current study quantitatively compares this self-retaining technique with the traditional manual technique. In 65 consecutive DA THA hips, two "best-view" digital photographs were taken of the exposure-one using Charnley/self-retaining retractors and one using a traditional three-retractor manual technique.

Anatomic Total Hip Component Position Is More Reproducible With the Direct Anterior Approach Using Intraoperative Fluoroscopy.

Background: Total hip arthroplasty (THA) has demonstrated excellent results regardless of the surgical approach. However, the approach used may be a factor in final positioning of implants. We hypothesized that the direct anterior approach (DAA) with fluoroscopy would be associated with more anatomic implant positioning than the posterior approach (PA).

The Direct Anterior Approach Total Hip Arthroplasty Reliably Achieves "Safe Zones" for Combined Anteversion.

Background: In total hip arthroplasty (THA), component position is critical to avoid instability and improve longevity. Appropriate combined femoral and acetabular component anteversion is important for improved THA stability and increased impingement-free range of motion. In direct anterior THA (DA-THA), concern has been expressed regarding the accuracy of femoral component positioning.

Acetabular Revision via Direct Anterior Approach-Technical Considerations.

Acetabular implant revision is commonly performed during revision total hip arthroplasty (THA). With recent significant increase in the utilization of direct anterior approach for primary THA, many surgeons familiar with this approach are exploring the direct anterior for revision THA (r-THA) applications. This chapter will specifically address acetabular implant revision via direct anterior approach.

Extensile Femoral Exposure/Femoral Revision Techniques Via the Direct Anterior Approach.

The goal of this chapter is to describe the extensile femoral exposure options and femoral revision techniques using the direct anterior approach (DAA) in total hip arthroplasty. Although DAA is initially described as a muscle-sparing exposure for primary hip arthroplasty, because of its internervous anatomic dissection, the internervous and intermuscular benefits of the DAA are maintained throughout the revision exposure. This distinguishing feature of the DAA must be respected to promote maximal muscle function and stability following revision surgery.

Dual Mobility for Monoblock Metal-on-Metal Revision-Is It Safe?

Background: Revision of monoblock metal-on-metal (MoM) total hip arthroplasty (THA) is associated with high complication rates. Limited revision by conversion to a dual mobility (DM) without acetabular component extraction may mitigate these complications. However, the concern for polyethylene wear and osteolysis remains unsettled.

Repair of the Released Conjoined Tendon After Direct Anterior Total Hip Arthroplasty.

Release of the conjoined tendon has been reported to facilitate femoral exposure during a direct anterior hip approach. However, the authors are not familiar with any description of an anterior approach repair technique for this important structure. Conjoined tendon repair is commonly performed in the posterior approach to help preserve hip biomechanics and restore anatomic tissue planes.

Early Failure of Primary Total Hip Arthroplasty: Is Surgical Approach a Risk Factor?

Background: In an era of innovation in surgical approaches for total hip arthroplasty (THA), there is concern for increasing trends of early failure. The purpose of this study is to evaluate the incidence of early failure of primary THA stratified by surgical approach.

Methods: A retrospective review was performed on consecutive primary THAs completed from 2007 to 2014 at a high-volume center.

Radiation Exposure During Fluoro-Assisted Direct Anterior Total Hip Arthroplasty.

Background: Utilization of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased in the last decade with fluoroscopy often used to confirm implant position, leg length, and offset. Radiation exposure thresholds around 800 mGy are published for the risk of cataracts. We hypothesized that surgeon eye exposure during fluoro-assisted DAA total hip arthroplasty would be well below these published thresholds.

Incidence of perioperative events in single setting bilateral direct anterior approach total hip arthroplasty.

The peri-operative complication rates of a single setting bilateral direct anterior approach (DAA) total hip arthroplasty (THA) are not well known. All single setting (90) bilateral DAA THA patients were reviewed. Blood loss was 632 mL for single setting bilateral DAA procedures.

Five year results of the first US FDA-approved hip resurfacing device.

A prospective, multi-center postmarket approval study has been ongoing since May 2006 to assess safety and efficacy of the first US FDA approved hip resurfacing implant. 265 patients have been enrolled at five study sites. The average age of the patients is 51.

Comparative analysis of periarticular osteolysis in modern total hip bearings: a minimum 5-year study.

The best bearing to use in the young active population remains unknown because there are currently no evidence-based data to rely on. This article compares the prevalence of periacetabular osteolysis using computerized tomography in patients with metal-on-metal, ceramic-on-ceramic, and metal-on-cross-linked bearings at a minimum 5-year follow-up.

Early failures in unicondylar arthroplasty.

Unicondylar arthroplasty has reemerged as an option for isolated compartment knee arthritis. We have noticed an increase in the need for early revision of this construct at our revision center. This study sought to determine if the need for unicondylar revision has increased over time and what factors may have led to early failure.

Comparison of autograft vs allograft in opening-wedge high tibial osteotomy.

Opening-wedge high tibial osteotomy (HTO) is used to treat isolated medial knee joint arthritis. A benefit of using allograft instead of autograft is avoiding a second surgical site, thereby decreasing operative time, blood loss, and pain. Our study objective was to evaluate allograft vs autograft in the failure and complication rates of HTO using the same technique and implant system (Arthrex HTO plate system, Arthrex, Inc, Naples, Fla).

Cementless femoral components in young patients: review and meta-analysis of total hip arthroplasty and hip resurfacing.

The study purpose was to analyze current results of modern cementless femoral components in young patients having total hip arthroplasty (THA) or hip resurfacing. Twenty-two studies (n = 5907; hips = 6408) evaluating modern cementless THA in young patients and 15 studies evaluating hip resurfacing (n = 3002; hips = 3269) were included. Meta-analysis techniques were used to pool failure rates.

Why revision total hip arthroplasty fails.

Unlabelled: Current outcomes data on revision total hip arthroplasty focuses on specific implants and techniques rather than more general outcomes. We therefore examined a large consecutive series of failed THAs undergoing revision to determine if survivorship and modes of failure differ in comparison to the current data. We retrospectively reviewed the medical records of 1100 revision THAs.

Locked plating of supracondylar periprosthetic femur fractures.

Fifty periprosthetic supracondylar femur fractures above a total knee arthroplasty were reviewed. Fractures were closed Lewis and Rorabeck type II with a stable prosthesis. Twenty-nine patients (group I), were treated with locked condylar plating.

Patient out-of-pocket expenses in major orthopedic procedures: total hip arthroplasty as a case study.

Total hip arthroplasty (THA) is a successful procedure for improving quality of life. There are few publications regarding out-of-pocket expenses incurred by individuals undergoing uncomplicated THA. Detailed billing and record reviews and patient phone surveys were conducted on 34 Medicare patients identifying charges and reimbursements recorded by the health care system and all out-of-pocket expenses incurred by patients undergoing uncomplicated THA (diagnostic related group [DRG] 209/current procedural terminology [CPT] 27130).

Sequelae of pediatric hip disorders: survey responses from experts in adult hip reconstruction.

Questions persist concerning the incidence of total hip arthroplasties (THAs) attributable to secondary osteoarthrosis and the impact of corrective pediatric hip surgeries and retained internal fixation on subsequent THAs. Hip reconstruction fellowship directors (N = 72) were mailed a survey of multiple-choice questions about pediatric hip disorders (PHDs) in their THA populations, the influence of hip osteotomies on subsequent THAs, and the recommendation to routinely remove pediatric hip internal fixation. Forty-five surgeons (62.

Surgical treatment of flexion contractures after total knee arthroplasty.

The goal of knee arthroplasty is to relieve pain and normalize range of motion while providing stability through the gait cycle. Postoperative, significant (>15 degrees ) flexion contractures can cause persistent pain and altered gait mechanics. This study evaluated the efficacy of revision surgery for painful flexion contractures.

Zirconia femoral head fractures: a clinical and retrieval analysis.

Zirconia femoral heads provide increased fracture strength, but 343 zirconia head failures have been documented since 2000. Retrieval analysis of 6 fractured heads, 4 suspect heads, 4 control zirconia heads, and 2 failed alumina heads was performed. Zirconia failures have been isolated to heads sintered in a "tunnel" furnace introduced in 1998.

Spinal osteochondroma presenting as atypical spinal curvature: a case report.

Study Design: The case of an 8-year-old girl with hereditary multiple exostosis presenting with atypical spinal curvature is reported.

Objective: To describe a case of spinal curvature caused by an osteochondroma, illustrating the need for careful evaluation of patients with hereditary multiple exostosis presenting with "scoliosis."

Summary Of Background Data: Osteochondromas have been known to arise in the spinal canal and to present with symptoms of neural compression.