Abstract Background The effect of fixed spinal deformities on a functional pelvis from standing to sitting is not fully understood. We aimed to assess the change in preoperative sagittal pelvic tilt ...angle (SPTA) from standing to sitting in patients undergoing total hip arthroplasty, comparing flexible and fixed spinal deformities. Methods Between July 2011 and October 2011, 68 consecutive unilateral total hip arthroplasties were implanted in 68 patients with a mean age of 71 ± 6 years. Fixed spinal deformity was defined as <10° of the change in SPTA from standing to sitting. Preoperative radiographic evaluation included standing (weight-bearing) anteroposterior and lateral pelvic and lumbosacral radiographs and a sitting lateral pelvic radiograph. Results The mean standing and sitting SPTA was 3.7° of anterior tilt and 17.7° of posterior tilt, respectively (change of 21.4 ± 12.5°). Seventy-five percent had flexible pelvises, all of which had a posterior tilt from standing to sitting. One patient in the fixed pelvis (1.4%) had a loss of posterior tilt from standing to sitting. The mean change of SPTA from standing to sitting in the fixed and flexible pelvis groups was 5.9 ± 3.5° to 26.7 ± 9.6° of posterior tilt, which was statistically significant ( P < .05). Conclusion There was a significant change in sagittal pelvic tilt from standing to sitting, especially in patients with a flexible spine, in which the functional anteversion increases with sitting. The patients with a fixed pelvis had significantly less SPTA in standing (less anteversion) with less posterior sagittal tilt in sitting, which should be incorporated in cup positioning.
Abstract Improved pain management techniques and accelerated rehabilitation programs are revolutionizing our patients' postoperative experience after total hip and knee arthroplasty. The process ...involves regional anesthesia with multimodal pain control using local periarticular injections in combination with enhanced patient education and accelerated rehabilitation provided by a dedicated team of surgeons, physicians, anesthesiologists, physician assistants, physical therapists, and social workers. With this system, it is now possible to achieve a painless recovery after total hip arthroplasty and total knee arthroplasty. Although this is not always the case, it was unheard of in prior years. It is our hope that future research into this area will make painful, difficult recoveries after total hip arthroplasty and total knee arthroplasty a distant memory.
Abstract Cup positioning is an important variable for short and long term function, stability, and durability of total hip arthroplasty (THA). This novel method utilizes internal and external bony ...landmarks, and the transverse acetabular ligament for positioning the acetabular component. The cup is placed parallel and superior to the transverse ligament and inside the anterior wall notch of the true acetabulum, then adjusted for femoral version and pelvic tilt and obliquity based on weight bearing radiographs. In 78 consecutive THAs, the mean functional anteversion and abduction angles were 17.9 ° ± 4.7 ° and 41.7 ° ± 3.8 °, respectively. 96% of the functional anteversion measurements and 100% of the functional abduction angles were within the safe zone. This technique is an easy, reproducible, and accurate method for functional cup placement.
Abstract The use of tapered, fluted, modular, distally fixing stems has increased in femoral revision surgery. The goal of this retrospective study was to assess mid-term to long-term outcomes of ...this implant. Seventy-one hips in 70 patients with a mean age of 69 years were followed for an average of 10 years. Preoperative HHS averaged 50 and improved to 87 postoperatively. Seventy-nine percent hips had Paprosky type 3A or more bone-loss. All stems osseointegrated distally (100%). Two hips subsided > 5 mm but achieved secondary stability. Sixty-eight percent hips had evidence of bony reconstitution and 21% demonstrated diaphyseal stress-shielding. One stem fractured near its modular junction and was revised with a mechanical failure rate of 1.4%. Distal fixation and clinical improvement were reproducibly achieved with this stem design.
Abstract Anterior knee pain (AKP) has been a persistent complaint after total knee arthroplasty; however, the natural course of this complaint has not been fully investigated. This is a 10-year ...follow-up report of a prospective, randomized study between the Insall-Burstein II (Zimmer, Warsaw, IN) and the Press Fit Condylar Modular (Johnson & Johnson, Raynham, MA) knees. Up to one third of total knee arthroplasties will experience mild to moderate AKP at 1-year follow-up, which will persist in approximately 30% of these previously symptomatic knees at 10-year follow-up. New-onset AKP will develop in approximately 10% of previously asymptomatic knees.
Abstract Introduction In recent time, metal ion debris and adverse local tissue reaction (ALTR) have reemerged as an area of clinical concern with the use of large femoral heads after total hip ...arthroplasty (THA). Materials and Methods Between June 2014 and January 2015, 60 patients with a non-cemented THA using a titanium (TMZF alloy) femoral stem and a V40 trunnion were identified with a minimum 5-year follow-up. All THAs had a 32-or 36-mm metal (n=30) or ceramic (n=30) femoral head coupled with highly cross-linked polyethylene. Cobalt, chromium and nickel ions were measured. Results Patients with metal heads had detectable cobalt and chromium levels. Cobalt levels were detectable in 17(56.7%) patients with a mean of 2.0μg/L (range: <1.0μg/L to 10.8μg/L). Chromium levels were detectable in 5(16.7%) patients with a mean of 0.3μg/L (range: <1.0μg/L to 2.2μg/L). All patients with a ceramic head had non-detectable cobalt and chromium levels. Cobalt and chromium levels were significantly higher with metal heads compared to ceramic heads (p<0.01). Cobalt levels were significantly higher with 36-mm metal heads compared to 32-mm heads (p<0.01). Seven patients with metal femoral heads had mild hip symptoms, four of which had positive findings of early adverse local tissue reaction on MRI. All ceramic THA were asymptomatic. Conclusions The incidence and magnitude of cobalt and chromium levels is higher in metal heads compared to ceramic heads with this implant system(p <0.01). 36-mm metal femoral heads result in larger levels of cobalt compared to 32-mm metal heads.
Abstract Introduction The presence of hand OA increases the risk for developing OA in other major joints. Although genetic predisposition has been implicated in its causation, its exact role has yet ...to be established. The association of hand OA with symptomatic and asymptomatic major joint(s) has not been previously studied. Material and Methods 100 consecutive patients had a hand photo taken for visual documentation of the hand joints. Radiographs of hand and all major symptomatic joint(s) were analyzed and classified using the Kellgren-Lawrence (KL) scale by two independent observers including an orthopaedic radiologist. Results Severe hand OA was present in 91% of the patients. Radiographic analysis showed the hip was involved in 88% of the patients, of whom 85.2% (75) were symptomatic and 14.7% (13) were asymptomatic. 62.5% (55) of symptomatic hip patients required hip replacement. Knee involvement was present in 37% of the patients and all were symptomatic and 81.1% (30) of these required knee replacement. 33% (28) had bilateral and 6% (5) had ‘two joint (hip&knee)’ surgery. Spine involvement was present in 72% of the patients. There was a significant correlation between hand radiographic findings of OA and hip (r=0.68;p=0.03), knee (r=0.58;p=0.042), and spine (r=0.39;p=0.05) involvement. Conclusions There was a significant correlation between severe hand OA and hip, knee and spine involvement. Severity of Hand OA can have a predictive value on multiple joint involvement and risk of surgical intervention. This study emphasizes the need to investigate the genetic predisposition in causation of OA.
Abstract The purpose of this study was to assess the durability of a non-cemented, hemispherical rim-fit, hydroxyapatite coated cup with a highly cross-linked polyethylene in 223 total hip ...arthroplasties. At 6-years follow-up (range, 5–9), there were no cup revisions for osteolysis or loosening. Radiologic evidence of osseointegration was based on presence of Stress Induced Reactive Cancellous Bone and radial trabeculae, seen in 47% and 93% of cups, respectively; both were most prevalent in Zone 1. There was no interference demarcation in any zones. Two cups were revised (0.9%): one for dislocation and another for infection. The Kaplan–Meier survivorship for cup revision for any failure (infection, dislocation) was 99% and for mechanical failure (osteolysis, loosening) was 100%. This design has excellent safety, efficacy and durability.
Abstract The purpose of this study was to analyze wear rates of highly cross-linked polyethylene comparing the Martell and the Roman methods in 112 total hip arthroplasties in patients 65 years and ...younger, with a mean follow-up of 5.7 years. The mean wear rates in the Martell and Roman methods were 0.014 ± 0.05 mm/y and 0.011 ± 0.04 mm/y when including all values and 0.043 ± 0.028 mm/y and 0.038 ± 0.02 mm/y when negative values were assumed to be zero, respectively. Both Roman and Martell methods showed similar low wear rates with negative values. The Roman method had higher precision and was more user friendly because it required less steps to measure wear, especially when comparing with the manual feature of Martell method.
Abstract Routine patella replacement with total knee arthroplasty has not been universally adopted because of associated patellofemoral complications such as anterior knee pain (AKP). In the proposed ...technique, the articular surface of the lateral facet of the patella is excised to the depth of the subchondral bone, and the medial facet is then cut parallel to the anterior surface. We evaluated any correlation between various radiographic parameters and AKP in 100 consecutive fixed-bearing posterior-stabilized total knee arthroplasties. There were no cases of fracture, avascular necrosis, subluxation, dislocation, patellar baja, or overstuffing of the patella. Anterior knee pain was present in 11% of cases, and no cases were severe or disabling. There were no correlations between AKP, range of motion, patellar size and shape, and any of the radiographic parameters.
