Primary total hip arthroplasty: intraoperative decisions and surgical techniques.

Intraoperative decisions and surgical techniques are important factors in the success of a total hip arthroplasty. Each of the available surgical exposures has advantages and disadvantages. Reproducing accurate leg length and precisely implanting the acetabular and femoral components also are critical.

Basics of primary total hip arthroplasty: preoperative and postoperative decisions.

Preoperative planning, choice of implant-bearing surface materials to reduce wear, factors to minimize the incidence of postoperative dislocation, and the critical postoperative care issues to facilitate a rapid recovery are important considerations in patients undergoing total hip arthroplasty.

Intraneural ganglia in the hip and pelvic region. Clinical article.

Object: The authors describe their experience in a series of cases of intraneural ganglia within the hip and pelvic regions, and explain the mechanism of formation and propagation of this pathological entity.

Methods: Five patients with 6 intraneural ganglia are presented. Four patients presented with symptomatic intraneural ganglia in the buttock and pelvis affecting the sciatic and lumbosacral plexus elements.

Total hip arthroplasty in a patient with a contralateral hemipelvectomy.

Hemipelvectomy is a rare procedure performed for tumor resection or trauma. The limb may be spared, and the patients often require extensive rehabilitation. We report the outcome of a total hip arthroplasty (THA) in a patient with endstage hip arthritis in a high dislocated hip contralateral to a remote, traumatic hemipelvectomy.

Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. Surgical technique.

Background: It has been claimed that the two-incision total hip arthroplasty technique provides quicker recovery than other methods do. To date, however, there have been no studies that have directly compared the two-incision technique with another method in similar groups of patients managed with the same advanced anesthetic and rehabilitation protocol. We posed the hypothesis that patients managed with two-incision total hip arthroplasty would recover faster than those managed with mini-posterior-incision total hip arthroplasty and designed a randomized controlled trial specifically (1) to determine if patients recovered faster after two-incision total hip arthroplasty than after mini-posterior-incision total hip arthroplasty as measured on the basis of the attainment of functional milestones that reflect activities of daily living, (2) to determine if the general health outcome after two-incision total hip arthroplasty was better than that after mini-posterior-incision total hip arthroplasty as measured with Short Form-12 (SF-12) scores, and (3) to evaluate the surgical complexity of the two procedures on the basis of the operative time and the prevalence of early complications.

Case report: the nest technique for management of a periprosthetic patellar fracture with severe bone loss.

Periprosthetic patellar fracture with marked loss of bone stock presents a significant problem in total knee arthroplasty. Treatment outcomes are often unsatisfying and may lead to disruption of the extensor mechanism of the knee. We present a patient with a Type IIIb periprosthetic patellar fracture treated by a novel approach.

Surgical correction of "cam-type" femoroacetabular impingement: a cadaveric comparison of open versus arthroscopic debridement.

Purpose: The goal of this study was to compare open and arthroscopic surgical techniques for "cam-type" femoroacetabular impingement in terms of feasibility and reliability.

Methods: We used 5 fresh-frozen cadaver specimens (10 hips). Anteroposterior and cross-table radiographs were taken for each.

Postoperative patient falls on an orthopedic inpatient unit.

We are not aware of any data looking specifically at inpatient falls in an orthopedic ward. We reviewed all postoperative orthopedic patients who fell during 2003 and 2005 on a single postoperative orthopedic unit. Seventy patients (1%) fell, resulting in 2.

Hip disease in the young, active patient: evaluation and nonarthroplasty surgical options.

As a distinct entity, femoroacetabular impingement has been suggested to be a preosteoarthritic mechanism. The condition occurs when the proximal femur repeatedly comes into contact with the native acetabular rim during normal hip range of motion. Early diagnosis and surgical management are imperative to delay degenerative changes associated with these conditions.

Radiographic evaluation of the hip has limited reliability.

Radiographic evaluation provides essential information regarding the diagnosis and treatment of musculoskeletal disorders. We evaluated the ability of hip specialists to reliably identify important radiographic features and to make a diagnosis based on plain radiographs alone. Five hip specialists and one fellow performed a blinded radiographic review of 25 control hips, 25 hips with developmental dysplasia (DDH), and 27 with femoroacetabular impingement (FAI).

Labral reconstruction using the ligamentum teres capitis: report of a new technique.

We have used the ligamentum teres capitis to reconstruct the deficient or absent labrum in five patients with femoroacetabular impingement at the time of surgical hip dislocation. Two had a deficient labrum overlying a sectorial retroverted acetabulum causing pincer-type impingement. Three patients had the labrum previously resected arthroscopically.

Rate and risk factors for blood transfusion in patients undergoing periacetabular osteotomy.

Periacetabular osteotomy has become the procedure of choice in many centers for the treatment of symptomatic hip dysplasia in young patients without severe secondary hip arthritis. Reorientation pelvic osteotomy has the potential for large blood loss and the need for blood transfusion. Between 1996 and 2003, 108 periacetabular osteotomies (107 patients) were performed by one of the authors.

Inflammatory laboratory markers in periprosthetic hip fractures.

The purpose of this study was to determine the prevalence of increased inflammatory laboratory markers in patients with periprosthetic fractures. We also studied the likelihood of the elevation of these values in predicting deep prosthetic joint infection. From 2000 to 2006, 204 patients with periprosthetic hip fractures were treated at our institution.

Variability in hip range of motion on clinical examination.

The goal of this study was to determine the interobserver and intraobserver reliability of physical examination in determining hip range of motion. Twenty normal hips, 21 hips with osteoarthritis, and 21 hips of patients more than 12 months after a total hip arthroplasty were examined for visual passive range of motion. These 62 hips were examined by 2 experienced surgeons and by 3 trainees.

Wound closure and metabolic parameter variability in a db/db mouse model for diabetic ulcers.

Background: Diabetic foot ulcers are a major cause of nontraumatic lower extremity amputations. Wound-healing researchers commonly use db/db mice as a model for diabetes, while the excisional wound correlates well with chronic foot ulcers. Recent clinical trials identified a correlation between glycemic control and cardiovascular complications in diabetic patients.

Total knee arthroplasty after anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) injuries are common, and many of these patients go on to ACL reconstruction. At a later date, some may develop symptomatic osteoarthritis and require total knee arthroplasty (TKA). This raises the question: Does prior ACL reconstruction have a deleterious impact on the outcome of knee arthroplasty? Thirty-six cases of patients who underwent ACL reconstruction and then TKA at a later date were retrospectively reviewed.

Optimal fixation for the extended trochanteric osteotomy: a pilot study comparing 3 cables vs 2 cables.

The extended femoral trochanteric osteotomy allows excellent exposure of the proximal femoral canal, which facilitates resection of the canal's contents during revision total hip arthroplasty. Once the proximal femoral canal has been evacuated and a new femoral component has been placed, the osteotomy should be fixed in proper position to allow healing. The purpose of our study was to compare the fixation of an extended trochanteric osteotomy using 2 vs 3 braided cables with regard to stiffness, peak force, axial displacement, transverse displacement, and angular displacement using an in vitro biomechanical model.

Slower recovery after two-incision than mini-posterior-incision total hip arthroplasty. A randomized clinical trial.

Background: It has been claimed that the two-incision total hip arthroplasty technique provides quicker recovery than other methods do. To date, however, there have been no studies that have directly compared the two-incision technique with another method in similar groups of patients managed with the same advanced anesthetic and rehabilitation protocol. We posed the hypothesis that patients managed with two-incision total hip arthroplasty would recover faster than those managed with mini-posterior-incision total hip arthroplasty and designed a randomized controlled trial specifically (1) to determine if patients recovered faster after two-incision total hip arthroplasty than after mini-posterior-incision total hip arthroplasty as measured on the basis of the attainment of functional milestones that reflect activities of daily living, (2) to determine if the general health outcome after two-incision total hip arthroplasty was better than that after mini-posterior-incision total hip arthroplasty as measured with Short Form-12 (SF-12) scores, and (3) to evaluate the surgical complexity of the two procedures on the basis of the operative time and the prevalence of early complications.

Triplanar trochanteric osteotomy: a modified anterior trochanteric slide osteotomy.

Current methods of trochanteric sliding osteotomy typically preserve the lateral aspect of the greater trochanter, the vastus lateralis, the abductors, posterior capsule, and the external rotators. Our modification to this technique includes leaving an anterior vertical ridge of bone that resists the anterior-directed forces acting on the osteotomy. Furthermore, a chevron-shaped osteotomy provides some additional stabilization to the proximally directed pull of the abductors.

Efficacy of native and hyperglycosylated follicle-stimulating hormone analogs for promoting fertility in female mice.

Objective: To compare the efficacy of recombinant human FSH (rhFSH) with rhFSH with four additional O-linked carbohydrates (rhFSH-CTP), rhFSH with four additional N-linked carbohydrates (rhFSH-N4), and the current gold standard for rodent ovarian stimulation, pregnant mare serum gonadotropin (PMSG), on fertility parameters in mice.

Design: Animal study.

Setting: Academic research center.

Hybrid total knee arthroplasty analysis of component failures at an average of 15 years.

Hybrid total knee arthroplasty in which the femoral component is cementless and the tibial component is cemented remains controversial. We report on the long-term results of 65 total knee arthroplasties followed for an average of 15 years. There were 18 revisions (27%); of these, 11 were femoral component revisions.

Cemented total knee arthroplasty using a modern prosthesis in young patients with osteoarthritis.

Fifty-two consecutive cemented total knee arthroplasties were performed using the Press-Fit Condylar (DePuy, Warsaw, Ind) knee system on patients aged 55 years or younger at Mayo Clinic Rochester from 1988 to 1994. Patients were followed for a minimum of 10 years, with an average follow-up of 12 years (range, 10-15 years). There were 8 total revisions (15%), including 2 revisions before 10 years, one for sepsis at 1 year, and one for instability at 8 years.