Efficacy and Cost-effectiveness of Topical Vancomycin Powder in Primary Cementless Total Hip Arthroplasty.

Topical vancomycin has been shown to effectively reduce infections after spinal surgery while remaining safe and cost-effective; however, there are few studies evaluating topical vancomycin in total hip arthroplasty. The authors hypothesized that the incidence of periprosthetic joint infection would decrease with the use of topical vancomycin in total hip arthroplasty and that topical vancomycin would be cost-effective. A retrospective patient chart review was performed to evaluate consecutive primary cementless total hip arthroplasties performed in the authors' hospital system between April 2015 and December 2016.

Cobalt toxicity after revision to a metal-on-polyethylene total hip arthroplasty for fracture of ceramic acetabular component.

Cobalt metallosis after revision metal-on-polyethylene total hip arthroplasty for catastrophic failure of ceramic components is uncommon but a potentially devastating complication. Common findings associated with heavy metal toxicity include cardiomyopathy, hypothyroidism, skin rashes, visual disturbances, hearing changes, polycythemia, weakness, fatigue, cognitive deterioration, and neuropathy. We report a case of a 57-year-old woman who presented with complaints of progressively worsening hip pain, fatigue, memory loss, lower extremity sensory loss, persistent tachycardia, and ocular changes 5 years after synovectomy and revision of a failed ceramic-on-ceramic total hip arthroplasty to metal-on-polyethylene components.

Early catastrophic failure of trochanteric fixation with the Dall-Miles Cable Grip System.

Multi-filament orthopaedic cerclage cables have been used in clinical practice for several decades, and are commonly utilized to provide greater trochanteric fixation following an osteotomy or fracture. We present the first known report of patients who experienced early catastrophic failure following use of the Dall-Miles Cable Grip System (DMCGS). A root cause analysis determined that the jaws of one crimper had an increased distance at closure, resulting in inadequate ultimate fixation strength.

An improved method for cable grip fixation of the greater trochanter after trochanteric slide osteotomy.

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.

Modular femoral stem-sleeve junction failure after primary total hip arthroplasty.

The total hip prosthesis has evolved from the initial monoblock system developed by Charnley. Modularity of both the femoral and acetabular components, which allows the surgeon to assemble the prostheses just before or during the course of implantation, has now become standard. Modularity increases the number of implant parameter variables, allowing semicustom devices to be constructed.

Massive retroperitoneal hematoma during enoxaparin treatment of pulmonary embolism after primary total hip arthroplasty: case reports and review of the literature.

In light of the increasing use of enoxaparin for both prophylaxis and treatment of thromboembolic disease, the number of potential complications from this anticoagulant will also continue to increase. This article presents the first case of massive retroperitoneal hematoma during enoxaparin treatment of pulmonary embolism after a primary total hip arthroplasty and discusses several unique sequelae of the retroperitoneal hematoma. Retroperitoneal hematomas are often fatal, and treatment involves aggressive fluid resuscitation with possible surgical decompression.