Painful metal-on-metal total hip arthroplasty.

Two patients were evaluated for the possibility of hypersensitivity to a Metasul articulation (Centerpulse, Austin, Tex) coupled with total hip arthroplasty. Serum was tested with a lymphocyte proliferation assay, and the capsular tissues from the hip were examined for perivascular lymphocytes. The diagnosis of hypersensitivity to Metasul could not be confirmed in these patients, and ultimately, the painful hip arthroplasties were felt to be caused by a combination of musculoskeletal problems.

The risks of small community practice.

Small community practice has risks not present in a metropolitan practice. The practice is general orthopaedics and subspecialization does not thrive. The quality of consulting physicians and the community hospital may not be of the level desired.

The risk of product liability: orthopaedic surgeons can be trapped.

Orthopaedics has become the specialty that it is because of the technologic advancements of medicine in designing successful implants. However, the use of implants introduces a new risk of product failure. The orthopaedic surgeon needs to be aware of the potential consequences of the risks of use of devices in treating patients.

Self-inflicted risks of orthopaedic surgery.

The advancements in medicine, including orthopaedic treatment, since 1960 have so greatly improved quality of life that human nature has changed in its social goals. These technological innovations, especially the products created, have resulted in a self-inflicted increase in risk of practice. This risk will not be leveled until society recognizes that it expects that the physician not only be a healer, but able to fulfill the social goals of the patient.

Intraoperative monitoring for safety of bilateral total knee replacement.

Cardiopulmonary hemodynamics in 79 consecutive patients who had one-stage bilateral total knee replacements were monitored prospectively with a pulmonary artery catheter. The pulmonary vascular resistance, wedge pressure, pulmonary artery pressure, and systemic vascular resistance were measured before skin incision, 5 to 10 minutes after implanting the first total knee replacement, and after the second knee replacement. The second knee replacement was cancelled in five patients because the pulmonary vascular resistance after the first knee replacement was more than double the baseline, or above 200 dyne/second/cm(5).

Comparison of preoperative radiographs and intraoperative findings of fixation of hemispheric porous-coated sockets.

Background: The radiographic criteria for identification of loose cementless acetabular components have not been well established. The purpose of this study was to compare the radiographic appearance of a hemispheric porous-coated cementless cup fixed with screws with the intraoperative findings with regard to the fixation status.

Methods: The quality of the cup fixation was evaluated at fifty-two hip revisions that were performed, for reasons other than infection, at an average of 89.