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

Related Articles Mortality After Septic Versus Aseptic Revision Total Hip Arthroplasty: A Matched-Cohort Study. J Arthroplasty. 2013 Aug 9; Authors: Choi HR, Beecher B, Bedair H Abstract Mortality rates after revision total hip arthroplasty (THA) for periprosthetic sepsis were investigated in 93 patients and compared to 93 patients, matched for age, gender, year of surgery, who underwent revision for aseptic failures. The mortality rate was 33% (31/93) in the septic group and 22% (20/93) in the aseptic group at 5 and 6year follow-up, respectively (P=0.10). Patients in the septic group died on average 6years earlier (74 versus 80yrs; P<0.05) than those in the aseptic group. Charlson Comorbidity Index (CCI) was an independent predictor of mortality among the both groups (P<0.05), while age (P<0.01) was a predictor of mortality only in the aseptic group. While revision THA for sepsis alone did not predict increased mortality, a 33% mortality rate at five years in patients with an average age of 66years and earlier death by 6years compared to aseptic revisions is alarming. PMID: 23937921 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23937921?dopt=Abstract

Related Articles Operative treatment of acetabular fractures in the medicare population. Orthopedics. 2013 Aug 1;36(8):e1065-70 Authors: Hayes PJ, Carroll CM, Roberts CS, Seligson D, Lau E, Kurtz S, Ong K, Malkani AL Abstract The purpose of this study was to determine the incidence of and evaluate the risk for complications and mortality following open treatment of acetabular fractures in the Medicare population. Patients treated with open reduction and internal fixation (ORIF) for acetabular fractures were identified using current procedural terminology codes in a 5% national sample of Medicare records. Complications within 90 days and within 1 year were evaluated based on the presence of ICD-9-CM diagnosis codes and Current Procedural Terminology reoperation codes. A total of 1286 fractures were treated closed and 359 were treated with ORIF. Multivariate Cox regression was performed to compare complication rates and risk factors. The incidence of acetabular fractures in the Medicare population has increased by 29% since 1998. Complications in the ORIF group included cardiac complications, deep venous thrombosis, infection, pulmonary embolism, refixation, and conversion to total hip arthroplasty. Risk factors for complications with ORIF included advanced age and comorbidities. Mortality in the ORIF group was 14.4% at 1 year. The incidence of reoperation with conversion to total hip arthroplasty or revision fixation following ORIF is 10% and 15%, respectively. Further investigation is required to improve outcomes and decrease complications in this group of patients, especially cardiac, deep vein thrombosis, and infection.

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Related Articles Delamination of Tantalum Porous Coating From a TKA Due to Regional Dissemination of Debris. Orthopedics. 2013 Aug 1;36(8):600-4 Authors: Bonutti PM, Pivec R, Issa K, Kapadia BH, Banerjee S, Mont MA, Bauer TW Abstract Metallic debris from metal-on-metal bearings is a recognized mode of failure that may lead to implant loosening and periprosthetic soft tissue reactions. The sequelae of metallosis have been most commonly reported with respect to total hip arthroplasty. The authors report a rare case of metallosis following a hybrid metal-on-polyethylene total knee arthroplasty that used a porous tantalum tibial knee component. A total knee arthroplasty patient who presented with knee pain but normal radiographs was found to have delamination of her tibial component that resulted in marked periprosthetic soft tissue metallosis. PMID: 23937736 [PubMed - in process]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23937736?dopt=Abstract

Related Articles Persistent Structural Disease Is the Most Common Cause of Repeat Hip Preservation Surgery. Clin Orthop Relat Res. 2013 Aug 10; Authors: Clohisy JC, Nepple JJ, Larson CM, Zaltz I, Millis M, the Academic Network of Conservation Hip Outcome Research (ANCHOR) Members Abstract BACKGROUND: Hip preservation surgery has become more commonplace, yet when it fails, it is unclear why it does so. Understanding failed procedures should lead to improved surgical results. QUESTIONS/PURPOSES: The purposes of this study were to (1) characterize patients undergoing hip preservation surgery after prior procedures; (2) compare demographics, hip pain, and function in patients with prior procedures with those undergoing primary surgery; (3) determine the types of previous procedures and the reasons for secondary surgery; and (4) report the procedure profile of the secondary surgeries. METHODS: A prospective, multicenter hip preservation database of 2263 patients (2386 surgery cases) was reviewed to identify 352 patients (359 hips, 15% of the total) who had prior surgery. Patient demographics, type of previous surgery, diagnostic categories, clinical scores, and type of secondary procedure were recorded.

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Related Articles The Fate of Unplanned Retention of Prosthetic Articulating Spacers for Infected Total Hip and Total Knee Arthroplasty. J Arthroplasty. 2013 Aug 6; Authors: Choi HR, Freiberg AA, Malchau H, Rubash HE, Kwon YM Abstract Eighteen patients with periprosthetic joint infection (11 hips and 7 knees) treated by prosthetic articulating spacers retained their spacers and were followed up at an average of 43.8months(range, 13-78months). Fifteen patients maintained well-functioning spacers for an average of 42.7months, of which 4 patients died with the spacers in situ at an average of 48.7months. The mean Harris Hip Score and Knee Society knee and function scores of survivors were 92, 92, 88, respectively. Spacers were revised in 3 patients because of recurrent infection (n=1) at 24months and mechanical loosening (n=2) at 74 and 50months. Findings of this study suggest that a proportion of patients with unplanned retention of prosthetic spacers appear to function well up to 6years without necessarily requiring further surgical intervention. PMID: 23932758 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23932758?dopt=Abstract

Related Articles Transfer of Hip Arthroplasty Patients Leads to Increased Cost and Resource Utilization in the Receiving Hospital. J Arthroplasty. 2013 Aug 6; Authors: Kamath AF, Austin DC, Derman PB, Israelite CL Abstract Factors other than complexity of care often drive the transfer of orthopedic patients to tertiary centers. We sought to compare the demographics, diagnoses, insurance data, peri-operative outcomes and institutional costs of total hip arthroplasty patients transferred from outside facilities with those of patients derived from our clinics. We analyzed 419 consecutive patients as part of a prospective risk study. Transferred patients were older (P=0.01), less likely to have private insurance (P<0.0001), and more likely to be admitted on weekends (P=0.04). Both dislocation and fracture were more prevalent in transferred patients (P=0.04; P=0.003). Across all key metrics - including length of stay, mortality scoring, peri-operative complications, and direct and total costs - transferred patients more significantly strained the resources of our arthroplasty center. PMID: 23932757 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23932757?dopt=Abstract