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 Short-term Wear Evaluation of Thin Acetabular Liners on 36-mm Femoral Heads. Clin Orthop Relat Res. 2013 Jul 17; Authors: Johnson AJ, Loving L, Herrera L, Delanois RE, Wang A, Mont MA Abstract BACKGROUND: Dislocation remains the leading cause of revision THA. One approach to decreasing prosthetic dislocation risk has been the use of larger femoral head component sizes. The upper limit of head size in metal-on-polyethylene hip arthroplasty has historically been limited because of concerns about increased wear on thin polyethylene components. It is not known to what degree this concern should apply to more wear-resistant polyethylene components. QUESTIONS/PURPOSES: We therefore determined (1) in vitro wear rates of polyethylene liners of varying thicknesses, (2) whether there were differences in the microscopic wear characteristics as a function of polyethylene thickness, and (3) whether thin polyethylene components resulted in early catastrophic failures. METHODS: We used a hip wear simulator to compare the wear performance of 12 highly crosslinked polyethylene acetabular inserts. The internal diameter of all components was 36 mm, and there were three samples tested of each thickness (1.9, 3.9, 5.9, or 7.9 mm). Testing was conducted for 2.4 million cycles. Gravimetric mass loss was converted to volumetric loss, which was subsequently converted to theoretical linear penetration rates.

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Related Articles Continuing Clopidogrel During Elective Total Hip and Knee Arthroplasty: Assessment of Bleeding Risk and Adverse Outcomes. J Arthroplasty. 2013 Jul 12; Authors: Jacob AK, Hurley SP, Loughran SM, Wetsch TM, Trousdale RT Abstract Limited research assessing risks of continued clopidogrel perioperatively in patients undergoing elective orthopedic procedures exists. Patients that underwent elective primary or revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) from 2007 to 2012 while taking clopidogrel at the time of surgical evaluation were retrospectively identified. Patient demographics, last dose of clopidogrel, intraoperative blood loss, blood transfusion, and presence of 30-day adverse cardiac events (ACE) were collected. Of 142 patients meeting criteria, 24 (16.9%) patients remained on clopidogrel perioperatively. Patients that continued clopidogrel were more likely to receive a blood transfusion within 24hours of surgery (31.8% vs. 7.7%; P=0.004) and during hospitalization (37.5% vs. 15.3%; P=0.02), but the incidence of 30-day ACE was not significantly different. Continuation of clopidogrel perioperatively for elective THA or TKA should be carefully considered. PMID: 23856063 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23856063?dopt=Abstract

Related Articles Proximal Femoral Replacement in the Management of Acute Periprosthetic Fractures of the Hip: A Competing Risks Survival Analysis. J Arthroplasty. 2013 Jul 12; Authors: Colman M, Choi L, Chen A, Crossett L, Tarkin I, McGough R Abstract To examine the mortality and implant survivorship of proximal femoral replacement (PFR), revision total hip arthroplasty (REV) and open reduction internal fixation (ORIF) in the treatment of acute periprosthetic fractures of the proximal femur, we retrospectively reviewed 97 consecutive acute periprosthetic proximal femoral fractures from 2000 to 2010. Three groups were defined: PFR (n=21), REV (n=19), and ORIF (n=57). Outcome measures were all-cause mortality, implant failure, and reoperation. Competing Risks survival analysis of overall mortality during the mean 35-month follow-up showed no statistical difference between the three groups (P=0.65; 12 and 60month mortality for PFR: 37%, 45%; REV: 16%, 46%; ORIF: 14%, 100%). Implant survival was worse for the PFR group (P=0.03, 12 and 60-month implant failure rate for PFR: 5%, 39%; REV: 7%, 7%; ORIF 2%, 2%). We conclude that PFR as compared with REV or ORIF may have worse medium-term implant survival, primarily due to instability and dislocation. PMID: 23856062 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23856062?dopt=Abstract

Related Articles Partial Two-stage Exchange for Infected Total Hip Arthroplasty: A Preliminary Report. Clin Orthop Relat Res. 2013 Jul 13; Authors: Ekpo TE, Berend KR, Morris MJ, Adams JB, Lombardi AV Abstract BACKGROUND: One common approach to the infected total hip arthroplasty (THA) calls for a staged revision, including removal of all components. However, removal of well-fixed femoral components can result in bone loss and compromised fixation; it is not known whether it is effective to leave a well-fixed femoral component in situ, remove only the acetabular component, débride thoroughly, place a spacer, and delay reimplantation. QUESTIONS/PURPOSES: The purposes of this study were to determine (1) the frequency of infection recurrence; (2) the frequency of death; and (3) the Harris hip scores of patients treated with a "two-stage partial exchange" approach.

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Related Articles Multidisciplinary Treatment in Patients With Persistent Pain Following Total Hip and Knee Arthroplasty. J Arthroplasty. 2013 Jul 9; Authors: Merle C, Brendle S, Wang H, Streit MR, Gotterbarm T, Schiltenwolf M Abstract In a retrospective study, we evaluated the clinical outcome of multidisciplinary pain therapy (MPT) in a consecutive series of 40 patients with persistent unexplained pain following THA or TKA. Pain intensity, physical capability and psychological status were assessed before MPT (t1), after 3weeks (t2) and at a mean follow-up of 32months (t3). At t2, all scores demonstrated a significant improvement compared to the baseline value. At t3, pain intensity, physical capability, and depression levels deteriorated slightly but were still significantly better compared to baseline values. Anxiety scores deteriorated between t2 and t3 and showed no difference in the baseline value. The present study suggests that MPT has beneficial short-term and mid-term effects in this subgroup of patients and may avoid exploratory revision surgery. PMID: 23849511 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23849511?dopt=Abstract

Related Articles Acetabular Reconstruction Using a Kerboull Cross-Plate, Structural Allograft and Cemented Dual-Mobility Cup in Revision THA at a Minimum 5-Year Follow-Up. J Arthroplasty. 2013 Jul 9; Authors: Wegrzyn J, Pibarot V, Jacquel A, Carret JP, Béjui-Hugues J, Guyen O Abstract The current study aimed to evaluate the outcome of a continuous and prospective series of 61 revision THAs with AAOS grade III and IV acetabular bone defect reconstruction using a Kerboull cross-plate, structural allograft and cemented dual mobility cup (Saturne, Amplitude, Valence, France). At a 7.5-year mean follow-up, no instability was reported after revision. In addition, no failure of the acetabular reconstruction was observed in 98% of the patients with complete allograft osseointegration and no evidence of mechanical rupture of the Kerboull cross-plate and/or loosening of the cemented dual mobility cup. In conclusion, such reconstruction technique demonstrated excellent results at mid-term follow-up in terms of prevention of instability after revision, restoration of the acetabular bone stock, and stable cemented fixation of the dual mobility cup. PMID: 23849510 [PubMed - as supplied by publisher]Read more... http://www.ncbi.nlm.nih.gov/pubmed/23849510?dopt=Abstract