Hip

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 Is TKA Using Patient-specific Instruments Comparable to Conventional TKA? A Randomized Controlled Study of One System. Clin Orthop Relat Res. 2013 Aug 2; Authors: Roh YW, Kim TW, Lee S, Seong SC, Lee MC Abstract BACKGROUND: Patient-specific CT-based instrumentation may reduce implant malpositioning and improve alignment in TKA. However, it is not known whether this innovation is an advance that benefits patients. QUESTIONS/PURPOSES: We evaluated (1) the precision of patient-specific TKA by comparing the incidence of outliers in postoperative alignment between TKAs using patient-specific instruments and TKAs using conventional instruments, and (2) the reliability of patient-specific instruments by intraoperatively investigating whether the surgery could be completed with patient-specific instruments alone.

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Related Articles Should Draining Wounds and Sinuses Associated With Hip and Knee Arthroplasties Be Cultured? J Arthroplasty. 2013 Jul 29; Authors: Tetreault MW, Wetters NG, Aggarwal VK, Moric M, Segreti J, Huddleston JI, Parvizi J, Della Valle CJ Abstract We assessed the utility of culturing draining wounds or sinuses in evaluating periprosthetic joint infection (PJI). Fifty-five patients with a draining wound or sinus after total joint arthroplasty (28 knees, 27 hips) who had not received antibiotics for at least two weeks were prospectively studied. Superficial wound cultures were compared to intra-articular cultures to determine accuracy in isolating infecting organism(s). The superficial cultures were concordant with deep cultures in 26 of 55 cases (47.3%) and were more likely to generate polymicrobial results (27.3% vs. 10.9%; P=0.023). In 23 cases (41.8%), the superficial cultures would have led to a change in antibiotic regimen. Superficial cultures yielded bacterial growth in 8 of the 10 cases (80%) when deep cultures and further work-up suggested the absence of deep infection. Given the potential to misguide diagnosis and treatment, we recommend against obtainment of superficial cultures in patients with a draining wound or sinus following hip or knee arthroplasty. PMID: 23906868 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23906868?dopt=Abstract

Related Articles Correlation of Magnetic Resonance Arthrography with Revision Hip Arthroscopy. Clin Orthop Relat Res. 2013 Aug 1; Authors: McCarthy JC, Glassner PJ Abstract BACKGROUND: Arthroscopic approaches for the diagnosis and treatment of hip disorders are well established; however, there are limited data regarding revision hip arthroscopy. There have been several studies evaluating the findings of MR arthrography with primary hip arthroscopy, but to our knowledge, no study has evaluated the diagnostic value of MR arthrography before revision hip arthroscopy. QUESTIONS/PURPOSES: We obtained sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MR arthrography to detect labral lesions, chondral lesions and loose bodies before revision hip arthroscopy. METHODS: We performed a single-surgeon, retrospective review of 70 revision hip arthroscopies (62 patients) and assessed the association between MR arthrography findings and intraoperative findings. There were 43 females and 19 males with a mean age of 36 years (range, 17-59 years). Radiographic interpretation was performed by one of four fellowship-trained musculoskeletal radiologists at three institutions, who had at least 5 years of experience. Radiographic findings were compared with surgical findings by one of the authors for calculation of sensitivity, specificity, PPV, and NPV.

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Related Articles Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection. Clin Orthop Relat Res. 2013 Aug 1; Authors: Portillo ME, Salvadó M, Alier A, Sorli L, Martínez S, Horcajada JP, Puig L Abstract BACKGROUND: The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI). QUESTIONS/PURPOSES: We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis. METHODS: All patients undergoing revision surgery between July 2010 and January 2012 were included in a prospective cohort of 112 patients, and were classified as having had failure from aseptic loosening (56%), mechanical failure (15%), or PJI (29%). To make the diagnosis of PJI, at surgery we used a standardized enhanced diagnostic approach in all patients including sampling of five periprosthetic tissue specimens, sonication of removed prosthetic components, prolonged incubation of aerobic and anaerobic cultures, and multiplex PCR of sonication fluid in aseptic loosening cases. Kaplan-Meier survival and Cox proportional hazards

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Related Articles What Causes Unexplained Pain in Patients With Metal-on metal Hip Devices? A Retrieval, Histologic, and Imaging Analysis. Clin Orthop Relat Res. 2013 Jul 30; Authors: Nawabi DH, Nassif NA, Do HT, Stoner K, Elpers M, Su EP, Wright T, Potter HG, Padgett DE Abstract BACKGROUND: Adverse tissue reactions associated with metal-on-metal (MOM) hips are common in resurfacing and total hip arthroplasty (THA) designs. The etiology of these reactions in painful, well-positioned arthroplasties is inconsistently described. QUESTIONS/PURPOSES: The purposes of this study were to compare the (1) articular wear rates; (2) histologic findings; (3) synovial response on MRI; and (4) graded intraoperative tissue damage between well-positioned, MOM hips revised for unexplained pain and MOM hips revised for other reasons and to (5) determine whether the presence of a taper junction on a MOM articulation affects these four parameters in unexplained pain. METHODS: We retrospectively studied 88 patients (94 hips) who had undergone revision of either a hip resurfacing or a large-head (> 36 mm) THA. Thirty-five hips revised for unexplained pain were compared with a control group of 59 hips revised for other causes. Articular wear was measured using three-dimensional contactless metrology and histologic analysis was performed using the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) score. Preoperative MRI was performed on 57 patients to

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Related Articles Incorporating Patient-reported Outcomes in Total Joint Arthroplasty Registries: Challenges and Opportunities. Clin Orthop Relat Res. 2013 Jul 30; Authors: Franklin PD, Harrold L, Ayers DC Abstract BACKGROUND: Total joint arthroplasty (TJA) registries traditionally have focused on implant longevity and rates of revision surgery. Registries would benefit from the addition of standardized patient-reported outcomes (PROs) such as pain relief and improved physical function. However, PROs have not been routinely adopted, and their incorporation into TJA registries presents challenges. QUESTIONS/PURPOSES: We review current PRO use by existing national registries, challenges to integrating PROs in national registries, lessons from national registries that have integrated PROs, and suggestions to guide future adoption of PROs.

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