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Latest journal articles about hip arthroplasty and reconstruction from Journal of Arthroplasty, The Bone & Joint Journal, Journal of Bone and Joint Surgery, Clinical Orthopaedics and Related Research, Acta Orthopaedica, Orthopedic Clinics of North, America, Journal of Orthopaedic Surgery and Research, Orthopedics
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Molecular characterization of articular cartilage from young adults with femoroacetabular impingement.
J Bone Joint Surg Am. 2013 Aug 21;95(16):1457-64
Authors: Hashimoto S, Rai MF, Gill CS, Zhang Z, Sandell LJ, Clohisy JC
Abstract
BACKGROUND: Femoroacetabular impingement is a frequent cause of hip pain and may lead to secondary osteoarthritis, yet little is known about the molecular events linking mechanical hip impingement and articular cartilage degeneration. The first goal of this study was to quantify the expression of inflammatory cytokine and chemokine, matrix-degrading, and extracellular matrix genes in articular cartilage harvested from control hips and hips with femoroacetabular impingement and end-stage osteoarthritis. The second goal was to analyze the relative expression of these genes in articular cartilage harvested at various stages of osteoarthritis.
METHODS: Cartilage samples were obtained from thirty-two hips undergoing hip preservation surgery for femoroacetabular impingement or hip arthroplasty. Three control cartilage samples were also analyzed. Specimens were graded intraoperatively with regard to the severity of cartilage damage, the radiographic osteoarthritis grade was recorded, and quantitative RT-PCR (real-time polymerase chain reaction) was performed to determine relative gene expression.
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Does the Direct Anterior Approach in THA Offer Faster Rehabilitation and Comparable Safety to the Posterior Approach?
Clin Orthop Relat Res. 2013 Aug 21;
Authors: Rodriguez JA, Deshmukh AJ, Rathod PA, Greiz ML, Deshmane PP, Hepinstall MS, Ranawat AS
Abstract
BACKGROUND: Newer surgical approaches to THA, such as the direct anterior approach, may influence a patient's time to recovery, but it is important to make sure that these approaches do not compromise reconstructive safety or accuracy.
QUESTIONS/PURPOSES: We compared the direct anterior approach and conventional posterior approach in terms of (1) recovery of hip function after primary THA, (2) general health outcomes, (3) operative time and surgical complications, and (4) accuracy of component placement.
METHODS: In this prospective, comparative, nonrandomized study of 120 patients (60 direct anterior THA, 60 posterior THAs), we assessed functional recovery using the VAS pain score, timed up and go (TUG) test, motor component of the Functional Independence Measure™ (M-FIM™), UCLA activity score, Harris hip score, and patient-maintained subjective milestone diary and general health outcome using SF-12 scores. Operative time, complications, and component placement were also compared.
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High Frequency of Adverse Local Tissue Reactions in Asymptomatic Patients With Metal-on-Metal THA.
Clin Orthop Relat Res. 2013 Aug 22;
Authors: Fehring TK, Odum S, Sproul R, Weathersbee J
Abstract
BACKGROUND: The key to successful management of patients with metal-on-metal (MOM) THAs is to diagnose adverse local tissue reactions (ALTRs) early. ALTRs have been described in asymptomatic patients with resurfacing arthroplasties. Whether this concerning finding applies to modular MOM THAs is unknown.
QUESTIONS/PURPOSES: We (1) determined the prevalence of ALTRs in asymptomatic patients with modular MOM THAs, (2) described any differences in the appearance of these lesions between symptomatic and asymptomatic patients, and (3) analyzed potential predictive factors for any associations with ALTR prevalence.
METHODS: We evaluated 114 patients with modular MOM THAs who had MRI with metal artifact reduction sequence software and metal ion laboratory results at a mean of 57 months postoperatively. There were 83 asymptomatic and 31 symptomatic patients. We defined ALTRs as abnormal fluid collections, solid or semisolid pseudotumors, or muscle or bone damage. Ion levels, lesion size, and cup abduction angles were analyzed.
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Understanding Readmission After Primary Total Hip and Knee Arthroplasty: Who's at Risk?
J Arthroplasty. 2013 Aug 16;
Authors: Saucedo JM, Marecek GS, Wanke TR, Lee J, Stulberg SD, Puri L
Abstract
Readmission has been cited as an important quality measure in the Patient Protection and Affordable Care Act. We queried an electronic database for all patients who underwent Total Hip Arthroplasty or Total Knee Arthroplasty at our institution from 2006 to 2010 and identified those readmitted within 90days of surgery, reviewed their demographic and clinical data, and performed a multivariable logistic regression analysis to determine significant risk factors. The overall 90-day readmission rate was 7.8%. The most common readmission diagnoses were related to infection and procedure-related complications. An increased likelihood of readmission was found with coronary artery disease, diabetes, increased LOS, underweight status, obese status, age (over 80 or under 50), and Medicare. Procedure-related complications and wound complications accounted for more readmissions than any single medical complication.
PMID: 23958236 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23958236?dopt=Abstract
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The Results of Total Hip Arthroplasty for Fractured Neck of Femur in Octogenarians.
J Arthroplasty. 2013 Aug 16;
Authors: Kieffer WK, Dawe EJ, Lindisfarne EA, Rogers BA, Nicol S, Stott PM
Abstract
The role of total hip arthroplasty (THA) for fracture in octogenarians remains unclear. Over a two-year period, 354 patients aged > 80years were admitted with a displaced intracapsular hip fracture. Using defined clinical guidelines, 38 patients underwent THA with a median age of 84years, mean follow-up of 20months. Primary outcomes were dislocation, 30-day and one-year mortality, revision surgery and periprosthetic fracture. There were no dislocations or periprosthetic fractures and patient survival was 97% at 30days and 87% at one year. There was one revision for deep infection. This study demonstrates that THA for selected octogenarians can be performed safely, allows the majority of patients to return to independent living and has a low complication rate.
PMID: 23958235 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23958235?dopt=Abstract
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Research Synthesis of Recommended Acetabular Cup Orientations for Total Hip Arthroplasty.
J Arthroplasty. 2013 Aug 16;
Authors: Harrison CL, Thomson AI, Cutts S, Rowe PJ, Riches PE
Abstract
Total hip arthroplasty (THA) is regarded as one of the most successful surgical procedures of modern times yet continues to be associated with a small but significant complication rate. Many early failures may be associated with poor component positioning with, in particular, acetabular component orientation dependent on the subjective judgement of the surgeon. In this paper, we compare the manufacturers' instructions on acetabular cup orientation with the literature-based recommended safety zones and surgical technique, by transforming them onto a single, clinically-relevant framework in which the different reference systems, safety guidelines and current instrumentation surgical techniques can be evaluated. The observed limited consensus between results reflects ongoing uncertainty regarding the optimum acetabular component positioning. As malpositioning of the acetabular cup increases the risk of revision surgery, any ambiguity over the correct position can have a causal effect. Our analysis highlights the need for a surgical reference system which can be used to describe the position of the acetabular cup intra-operatively.
PMID: 23958234 [PubMed - as supplied by publisher]
Read more... http://www.ncbi.nlm.nih.gov/pubmed/23958234?dopt=Abstract
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