Abstract The purpose of the present study was to analyze the longer-term results for a previously reported cohort of patients with cementless acetabular fixation and to compare the results with those ...for historical controls with cement fixation and a comparable follow-up period. One hundred and twenty consecutive nonselected total hip arthroplasties were performed in 108 patients with use of a cementless acetabular component. This series was evaluated at a minimum of twenty years of follow-up and was compared with 330 consecutive hip arthroplasties that had been performed by the same surgeon with use of cemented acetabular components and had been followed for a comparable period of time. Thirty-nine patients (forty-two hips) in the cementless fixation group were living at twenty years of follow-up. In the group of 120 hips with cementless acetabular fixation, twenty-two hips (18.3%) were revised during the follow-up period, but only one hip (0.8%) was revised because of loosening of the acetabular component, with no additional cup loosening since the previous report at thirteen to fifteen years of follow-up. In the group with cemented acetabular fixation with comparable follow-up, thirty-two hips (10%) were revised overall and eighteen hips (6%) were revised because of acetabular loosening. An additional twenty-five hips (8%) had acetabular cups that were loose on radiographs but had not undergone revision. At a minimum of twenty years of follow-up, cementless acetabular components provided superior long-term fixation compared with cemented components but the overall rates of acetabular revision for mechanical reasons were comparable. Level of Evidence Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Objective Medical education programs across the country are now required to conduct meaningful assessments of trainees’ competencies, although uniform standards for conducting these evaluations have ...yet to be established. In 1999, the Indiana University School of Medicine introduced a comprehensive competency-based undergraduate curriculum. The overall goal of the curriculum is to make medical students’ day-to-day experiences of training a source of learning about professionalism, communication, and aspects of medicine beyond factual knowledge. We sought to examine free-text comments by parents of pediatric inpatients as substrate for competency evaluation and feedback for third-year students on their pediatrics rotation. Methods The study was conducted from June 2001 to February 2004. Parents of hospitalized children completed a short medical student evaluation form that included 2 questions inviting free-text response. We used narrative analysis, a qualitative research technique, to describe both the content and meaning of the parents’ responses. Results We collected 573 evaluations with narrative comments about 412 students. The most common aspect of medical student performance commented on by parents related to communication (53.8%). The next most common narrative comment was some form of affirmation of the student as a health care professional (26.0%). Other themes included establishing context for the comment, perceptions of the health care system, criticizing medical student performance, perceptions of the role of medical students, physical approach to the patient, expression of humility by the student, holistic approach to the patient, physical appearance of the student, superlative description of student, and advocating for the patient. Multiple themes were identified in 232 narrative comments (40.4%). Examples of each theme are provided. Conclusions Family members of pediatric inpatients are a valuable source of information about medical student performance in at least 2 of the Accreditation Council for Graduate Medical Education competency areas (Communication and Professionalism). Themes identified in this study could be used to inform the design of a comprehensive 360-degree student evaluation strategy.
Background Third-body wear can adversely affect the outcome of total hip arthroplasty by causing increased polyethylene wear, osteolysis, and component loosening. We hypothesized that there would be ...greater generation and migration of metal debris to the bearing surfaces in hips in which cobalt-chromium cables were used to reattach the osteotomized greater trochanter when compared with hips in which stainless steel wires were used. Methods Between June 1981 and December 1983, 196 consecutive total hip arthroplasties were performed with use of an Iowa stem and a titanium-backed cemented acetabular component, with cobalt-chromium cable trochanteric reattachment. After nineteen to twenty years of follow-up, the patients were evaluated with regard to the depth of head penetration into the polyethylene (as a surrogate for wear), osteolysis, loosening, and the need for revision. The results were compared with those for a series of 304 total hip arthroplasties that were performed by the same surgeon from January 1984 to December 1985 with use of the same components and the same surgical technique, but with stainless steel wire trochanteric reattachment. The two groups had a comparable nineteen to twenty-year follow-up. All living patients (fifty-nine hips in the cable group and ninety-two hips in the wire group) had minimum ten-year follow-up radiographs. Results The polyethylene wear rate was 0.101 mm/yr for the cable group and 0.082 mm/yr for the wire group (p = 0.039). For the living patients, the rate of revision of the acetabular component because of aseptic loosening was 37.3% (twenty-two hips) for the cable group and 20.7% (nineteen hips) for the wire group (p = 0.025). The rate of acetabular osteolysis was 44% (twenty-six hips) for the cable group and 26% (twenty-four hips) for the wire group (p = 0.022). Kaplan-Meier analysis with revision of the acetabular component because of aseptic loosening as the end point demonstrated survival rates of 73.7% ± 9% and 83% ± 7% for the cable and wire groups, respectively, at twenty years (p = 0.03). Conclusions Because cable trochanteric attachment led to significantly greater polyethylene wear, osteolysis, acetabular loosening, and acetabular revision, presumably due to third-body metallic debris generation in this cemented total hip replacement construct, surgeons should be aware of the deleterious effects of third-body debris and avoid the use of potential debris generators in the total hip arthroplasty construct. If cable is used and fretting is recognized, especially with intra-articular migration of metallic material or nonunion of the greater trochanter, consideration should be given to cable removal. Level of Evidence Therapeutic Level III . See Instructions to Authors for a complete description of levels of evidence.
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