Clinical outcomes and hospital length of stay in 2,756 elderly patients with hip fractures: a comparison of surgical and non-surgical management.

Introduction: The purpose of this study was to compare the clinical outcomes of elderly hip fracture patients who received surgical treatment with those who received non-surgical treatment.

Methods: This retrospective study involved 2,756 elderly patients with hip fractures who were admitted over a six-year period. The patients' biodata, complications, ambulatory status at discharge and length of hospital stay were obtained from the institution's hip fracture registry.

Alignment Analyses in the Varus Osteoarthritic Knee Using Computer Navigation.

Osteoarthritic (OA) knees with severe extension varus deformity seem to have correspondingly more severe flexion varus, especially beyond a certain tibiofemoral angle. Clinical measurement of flexion varus and fixed flexion deformity (FFD), which had been difficult to perform because of the spatial alignment of the knee in flexion, was recently made possible with computer navigation. We conducted a study to evaluate the relationship of extension and flexion varus in OA knees and to determine whether severity of FFD in the sagittal plane correlates with severity of coronal plane varus deformity.

The application of minimally invasive surgical techniques. Part II: total knee arthroplasty.

Traditional surgical approaches often involve making large skin incisions and extensively dissecting healthy tissue to access diseased anatomy. Obviously more desirable is to make smaller incisions and more focused dissections and achieve the same postsurgical outcomes. Minimally invasive surgery (MIS) is gaining popularity in many orthopedic fields, but MIS techniques are not without risk.

The application of minimally invasive surgical techniques. Part I: total hip arthroplasty.

Traditional surgical approaches often involve making large skin incisions and extensively dissecting healthy tissue to access diseased anatomy. Obviously more desirable is to make smaller incisions and more focused dissections and achieve the same postsurgical outcomes. Minimally invasive surgery (MIS) is gaining popularity in many orthopedic fields, but MIS techniques are not without risk.

Comparing the analgesia effects of single-injection and continuous femoral nerve blocks with patient controlled analgesia after total knee arthroplasty.

We compared the analgesic effects of single-injection or continuous femoral nerve block (FNB) with intravenous patient controlled analgesia (PCA) opioids. Two hundred patients undergoing knee arthroplasty were randomized to one of the three regimens. Significant knee pain on movement at postoperative 24h was reduced with single-injection (OR 0.

Applying computer-assisted navigation techniques to total hip and knee arthroplasty.

Appropriate implant alignment is a major goal of total joint arthroplasty. Obtaining appropriate alignment typically involves making intraoperative decisions in response to visual and tactile feedback. Integrated computer-based systems provide the option of continuous real-time feedback and offer the potential to decrease intraoperative errors while enhancing the surgical learning experience.

Total hip arthroplasty in above-knee amputees: a case report.

There are previous case reports in the literature that describe total knee and total hip arthroplasty (THA) in below-knee amputees, but we could find no case reports on above-knee amputees (AKAs) who have severe osteoarthritis of the hip. We present a case involving an AKA who developed severe osteoarthritis of the ipsilateral hip. Out patient underwent THA with a satisfactory postoperative outcome.

Massive wear and metallosis of an Acetabular Cup System presenting as pseudodislocation.

In primary and revision total hip arthroplasty (THA), the acetabular component continues to pose greater challenges than the femoral component. Numerous factors lead to polyethylene wear, which subsequently affects primary THA survival. Progressive polyethylene wear is associated with the occurrence of osteolysis, especially overlying the acetabulum, which can lead to component loosening and subsequent revision.

Failure of constrained acetabular liner without metal ring disruption.

Constrained acetabular liners can fail leading to recurrent dislocation. Failure can occur at any of the five possible interfaces: bone-acetabular shell, acetabular shell-constrained liner insert, constrained liner insert-bipolar head, bipolar head- femoral head and femoral head-trunion. We report a patient who presented with dissociation of the cemented Osteonics acetabular constrained liner (Stryker-Howmedica-Osteonics, Rutherford, New Jersey).

Does stress shielding occur with the use of long-stem prosthesis in total knee arthroplasty?

A retrospective study conducted to evaluate the possible occurrence of stress shielding with the use of long-stem tibial prosthesis in total knee arthroplasty. Forty-one patients were reviewed (twenty-three standard prosthesis, eighteen long-stem prosthesis) and forty-one unoperated knee of the contralateral limb). Patients underwent bone mineral density assessment with a dual-energy X-ray absorptiometry (DEXA) bone densitometer for the hip and bilateral knees.

Patellar reconstruction using distal femoral autograft in a patellectomized patient undergoing total knee arthroplasty.

Patellectomized patients have less satisfactory clinical outcomes after total knee arthroplasty because of a decreased extensor mechanism efficiency and potential instability attributable to loss of anterior restraint. We report a patient, with a prior history of patellectomy, who underwent simultaneous patellar reconstruction using distal femoral autograft during the total knee arthroplasty. The patient has been followed up for 24 months with excellent postoperative knee scores with radiographically established graft viability.

Total hip arthroplasty for ankylosed hip secondary to heterotopic ossification.

Heterotopic ossification (HO) secondary to traumatic brain injury occurs at various sites and most commonly at the elbow, shoulder, and hip. There are few published reports on the assessment and surgical resection techniques of HO. A complete preoperative physical examination and radiologic assessment with a computed tomographic scan are important for the thorough evaluation of a patient.

Effect of anesthesia type on limb length discrepancy after total hip arthroplasty.

A retrospective study of 132 patients (63 spinal anesthesia and 69 general anesthesia) undergoing total hip arthroplasty was performed by 4 fellowship-trained adult reconstructive surgeons to determine the influence of anesthesia type on postoperative limb length and medial offset. Limb length discrepancy occurred in 87.0% of patients who received regional anesthesia as opposed to 47.

Surgical challenges in complex primary total hip arthroplasty.

Complex primary total hip arthroplasty (THA) is defined as primary THA in patients with compromised bony or soft-tissue states, including but not limited to dysplastic hip, ankylosed hip, prior hip fracture, protrusio acetabuli, certain neuromuscular conditions, skeletal dysplasia, and previous bony procedures about the hip. Intraoperatively, provisions must be made for the possible use of modular implants and/or bone grafts. In this article, we review the principles of preoperative, intraoperative, and postoperative management of patients requiring a complex primary THA.

Fixation systems of greater trochanteric osteotomies: biomechanical and clinical outcomes.

The development of cerclage systems for fixation of greater trochanteric osteotomies has progressed from monofilament wires to multifilament cables to cable grip and cable plate systems. Cerclage wires and cables have various clinical indications, including fixation for fractures and for trochanteric osteotomy in hip arthroplasty. To achieve stable fixation and eventual union of the trochanteric osteotomy, the implant must counteract the destabilizing forces associated with pull of the peritrochanteric musculature.

Massive femoral osteolytic lesion secondary to disengagement of a total knee tibial locking pin: case report.

The Anatomic Modular Knee (AMK; Depuy, Warsaw, Ind) was one of the first designs to incorporate a modular locking mechanism for the tibial insert; fixation was secured using a screw-in tibial tray-locking pin. This case report describes a patient who presented with instability and worsening knee pain 15 years following a primary total knee arthroplasty using the AMK prosthesis. Radiographs and intraoperative assessment revealed proximal migration of the tibial tray-locking pin into the medial femoral condyle resulting in a large osteolytic defect.

Clinical outcome of total hip arthroplasty using the normalized and proportionalized femoral stem with a minimum 20-year follow-up.

Currently, there are several femoral stem designs available for use, but few have an extended track record. We have previously reported on 10- and 15-year outcome studies of total hip arthroplasty (THA) using a cemented normalized and proportionalized femoral stem from a single surgeon series. This is a follow-up study reporting the minimum 20-year outcome of this femoral stem design.

Multidisciplinary management of orthopedic patients with sickle cell disease.

With pharmacological treatment, the lifespan of the patient with sickle cell disease can be extended to the sixth decade. Currently the only curative therapy for sickle cell disease is hemopoietic cell transplantation, which is still undergoing technical refinement. Most patients can be expected to undergo at least one orthopedic surgical procedure in their lifetime.

Midterm results of primary total knee arthroplasty using a dished polyethylene insert with a recessed or resected posterior cruciate ligament.

Use of a dished polyethylene insert in 114 total knee arthroplasties, all with the posterior cruciate ligament resected or recessed, was retrospectively studied. Patients were evaluated at a mean follow-up of 8.3 years.