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Rossmann M, Aljawabra A, Mau H, Citak M, Gehrke T, Klatte TO, Abdelaziz H. Utility of histopathological examination in aseptic revision total hip arthroplasty: a preliminary analysis. Hip Int 2024; 34:201-206. [PMID: 37670462 DOI: 10.1177/11207000231197743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
INTRODUCTION The utility of a routine histopathological examination in aseptic revision total hip arthroplasty (THA) has not been well explored. We aim to describe the approach and present the results of histopathological examination, focusing on its clinical usefulness in the setting of aseptic revision THA. METHOD We retrospectively reviewed 285 performed aseptic revision THA with available histopathological reports between 2015 and 2017 at a single institution. We described histopathological requests by the surgical team. Preoperative diagnoses, intraoperative findings, as well as histopathology and culture results were analysed. RESULTS 13 painful THAs (4.5%) had preoperatively unknown diagnoses. In 10 of them, potential causes of pain were intraoperatively identified. Histopathology confirmed these findings in 8 THAs. 19 THAs (6.7%) revealed unexpected positive cultures (UPC). Histopathology was negative for infection in 18 of them. Among 16 consultants, 3 surgeons requested histopathology in 47% of the cases (130/285), usually to exclude infection (101/285; 35%). Documentation for tissue sample location was lacking in 51% (145/285), and for question asked by the surgeon in 47% (135/285). CONCLUSIONS Histopathology is deemed a useful confirmatory tool in the context of ruling out infection in UPCs, and in documenting intraoperative findings in painful THAs with unknown preoperative diagnoses. Importantly, the approach to requesting histopathology should be optimised. Further large-scale studies, including cost analyses, are warranted to explore the usefulness of histopathology in routine utility.
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Affiliation(s)
- Markus Rossmann
- Department of Joint Replacement Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Alaa Aljawabra
- Department of Joint Replacement Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Hans Mau
- Department of Joint Replacement Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Mustafa Citak
- Department of Joint Replacement Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Thorsten Gehrke
- Department of Joint Replacement Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
| | - Till Orla Klatte
- Department of Trauma, Hand, and Reconstructive Surgery, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Hussein Abdelaziz
- Department of Joint Replacement Surgery, Helios ENDO-Klinik Hamburg, Hamburg, Germany
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Bouaicha W, Jlidi M, Elarbi M, Mallek K, Jaziri S, Abdennadher A, Daas S. Surgical management of neck of femur fractures in patients younger than sixty-five years: a comparative study of three fixation methods. INTERNATIONAL ORTHOPAEDICS 2023; 47:3099-3106. [PMID: 37801123 DOI: 10.1007/s00264-023-05997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/23/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE Several surgical implants have been used for the treatment of neck of femur fracture (NOF) in younger patients such as dynamic hip screw (DHS) and cannulated compression screw. However, the superiority of one or another osteosynthesis device remains a matter of debate. The aim of this work is to evaluate and compare three fixation modalities: Cannulated Hip Screws (CHS), DHS and DHS associated to anti-rotating screw for surgical treatment of femoral neck fracture in young adults. METHODS It is a retrospective comparative study of three series of NOF fractures treated surgically over a period of ten years; including young adult patients (age > 18 years and < 65 years) treated conservatively using closed or open reduction and internal fixation. All types of NOF fractures according to Garden classification were included. Pathological, basi-cervical fractures and fractures on previously operated hips were excluded. The minimum follow-up recommended was two years. Clinical evaluation was based on the Postel Merle d'Aubigné score (PMA), the visual analogue scale (VAS), the Parker score, and the Hip Disability and Osteoarthritis Outcome Score (HOOS score). Reduction quality was assessed on X-rays. RESULTS Our series included 72 patients that were divided in three groups: Group A: Fixation using cannulated hip screws (33 patients). Group B: Fixation using DHS only (21 patients). Group C: Fixation using DHS associated to anti-rotation screw (18 patients). The patients of group A had better PMA and VAS scores, but there was no statistically significant difference. However, a significant difference (p=0.001) was found for the HOOS score. The fractures treated with DHS associated with anti-rotating screws, had the highest loss of reduction in the vertical axis (Yp) with the highest femoral head collapse (Zp) values. Group A had the lowest loss of reduction in the horizontal axis (Xp). There was no significant difference between the three methods of osteosynthesis in terms of loss of correction though. CONCLUSION We found comparable results in terms of healing and complication rates and loss of reduction for the three groups with no significant difference. However, the HOOS score was significantly better in the cannulated hip screw group.
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Affiliation(s)
- Walid Bouaicha
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Mohamed Jlidi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia.
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia.
| | - Marouen Elarbi
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Karim Mallek
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
| | - Salma Jaziri
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Anaesthesia and Intensive Care, Mohamed Bourguiba Hospital, El Kef, Tunisia
| | - Achraf Abdennadher
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Orthopedics and Traumatology Department, Military Hospital of Instruction, Tunis, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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Rios GM, Lins CF, Quadros Junior MC, Nery RLA, Trindade RMC, Matos MA. Metallic artifact suppression with MAVRIC-SL in magnetic resonance imaging for assessing chronic pain after hip or knee arthroplasty. Radiol Bras 2023; 56:255-262. [PMID: 38204899 PMCID: PMC10775810 DOI: 10.1590/0100-3984.2023.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 01/12/2024] Open
Abstract
Objective To analyze the association between osteolysis at the prosthesis interfaces, as determined by magnetic resonance imaging (MRI) with multiacquisition variable-resonance image combination selective (MAVRIC-SL) sequences, and clinical severity after knee or hip arthroplasty, as well as to assess interobserver and intraobserver agreement on periprosthetic bone resorption. Materials and Methods This was a cross-sectional study of 47 patients (49 joints) under postoperative follow-up after knee or hip arthroplasty, with chronic pain, between March 2019 and August 2020. All of the patients completed the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. The component interfaces were evaluated and ordered into two groups: osseointegrated and osteolytic. Nonparametric tests were used. Results There were significant differences between the two groups in terms of the mean WOMAC scores: total (p = 0.010); stiffness domain (p = 0.047); and function (p = 0.011) domains. There was substantial interobserver and intraobserver agreement for most analyses of the components. Conclusion Periprosthetic osteolysis appears to be associated with clinical complaints of pain in the post-arthroplasty scenario, and MAVRIC-SL provides reproducible assessments. It could prove to be an important tool for orthopedists to use in the evaluation of challenging cases of chronic pain after arthroplasty.
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Adam MF, Khalifa AA, Abdelaal AM. Complex regional pain syndrome after multiple revision total hip arthroplasty surgeries. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2023; 47:21. [DOI: 10.1186/s42269-023-00994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/05/2023] [Indexed: 09/01/2023]
Abstract
Abstract
Background
Persistent pain after total hip arthroplasty (THA) is a real concern for the surgeon and is a significant cause of patient dissatisfaction; periprosthetic joint infection (PJI), aseptic loosening, and instability are among the common causes of painful THA. However, few rare causes have been reported in the literature; the complex regional pain syndrome (CRPS) was reported to occur after primary hip and knee arthroplasties. Case presentation: We present a female patient who had bilateral hip resurfacing when she was 28 years old after being diagnosed with bilateral hip avascular necrosis; over 16 years, she was satisfied. She started developing pain in her right hip in 2019, diagnosed as aseptic loosening, and a revision using a cementless THA was performed. Six months later, she was diagnosed with PJI, which was treated in two stages; after the first-stage revision THA, the patient complained of persistent pain in her lower leg with a burning sensation and change in skin color, not responding to conservative lines. During the second-stage revision THA and after receiving spinal anesthesia, the skin color of the right lower limb changed to normal. The postoperative diagnosis was made as CRPS, treated effectively with sympathetic block. At six months postoperative, the patient was pain-free, and the implants showed proper position. Conclusions: Although rare, CRPS could cause persistent pain after repeated hip surgeries, and the diagnosis is reached mainly by exclusion.
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Technical Considerations and Avoiding Complications in Total Hip Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202211000-00011. [PMID: 36733988 PMCID: PMC9668563 DOI: 10.5435/jaaosglobal-d-22-00234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 09/25/2022] [Indexed: 11/22/2022]
Abstract
Total hip arthroplasty (THA) is considered to be the surgical procedure of the 20th century. Current projections show that by 2030, primary THA is expected to grow by 171%, with revision THA expected to increase by 142% in the same time frame. Although complications are not common, when they occur, they can cause notable morbidity to the patient. Understanding the unique anatomy and needs of each patient will prepare the surgeon to avoid soft-tissue or bony injury, optimize prosthesis placement, and decrease the risk of infection. This article aims to highlight common causes of early revision THA and provide specific technical strategies to avoid these complications. Following a systematic approach to the primary THA and using these techniques will assist the surgeon in avoiding complications to revision hip arthroplasty.
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Conroy J, Caus S, Nelms NJ. A Case of Iliopsoas Bursitis With Compressive Femoral Nerve Palsy Treated With Iliopsoas Tendon Release. Arthroplast Today 2022; 14:148-153. [PMID: 35313716 PMCID: PMC8933726 DOI: 10.1016/j.artd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/12/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
Iliopsoas bursitis is a well-established cause of groin pain after total hip arthroplasty (THA), and it can become dramatically more complex when associated with neurovascular compression. Iliopsoas bursitis may be caused by a variety of pathologies in the setting of a THA but most frequently due to a prominent acetabular component or implant wear. Here we report a rare case of a female patient presenting with iliopsoas tendonitis, an accompanying femoral nerve palsy, and debilitating pain beginning 12 years after a previously successful primary THA without apparent implant wear. Ultimately, our patient was treated successfully with iliopsoas tendon release for anterior prominence of the acetabular component.
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Yang M, Yan C, Niu N, Lu Y, Yue W, Pan L. Analysis of the Need for Postoperative Drainage Application for Hip Arthroplasty: A Systematic Review and Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2069468. [PMID: 35251296 PMCID: PMC8894062 DOI: 10.1155/2022/2069468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To synthesize the evidence regarding the effect and safety of drainage after the hip arthroplasty in randomized control trials. BACKGROUND Although the standard of hip replacement has matured in recent years, the need for postoperative drainage is still controversial which also is a clinical problem that needs to be addressed. DESIGN A systematic review and meta-analysis based on the Cochrane methods and Prisma guideline. Data Resources. A systematic search of the Cochrane Library, PubMed, EMBASE, CINAHL, Ovid, Wan Fang database, CNKI, and CBM database was carried out from January 1, 2000, to December, 2021. Review Methods. The quality of included randomized controlled trials was assessed individually by two reviewers independently using criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0. RESULTS Nineteen randomized control trials involving 3354 participants were included in this analysis. From the above analysis, we can know that compared with nondrainage, there was a statistically significant difference in VAS score on the postoperative first day (SD = -0.6; 95% CI: -0.79, -0.41) and second day (SD = -0.38, 95% CI: -0.58, -0.18), hematocrit reduction (MD =2.89; 95% CI: 1.3, 4.48), blood transfusion rate (OR =1.47; 95% CI: 1.12, 1.92), change of thigh circumstance (SMD = -0.48; 95% CI: -0.66, -0.31), and hospital stay (MD = 1.06; 95% CI: 0.73, 1.39) in drainage. However, there were no statistically significant differences in hemoglobin and hematocrit level, hip function, total blood loss, transfusion volume, dressing use, and complications between them. CONCLUSION Drainage after hip arthroplasty can reduce swelling in the thigh and relieve pain while no drainage can bring down hematocrit reduction, decrease dressing uses, and shorten the hospital stay which promotes rapid recovery. This review provides a detailed theoretical reference for the proper clinical application of drains and improves the efficient use of resources.
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Affiliation(s)
- Min Yang
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
| | - Chunwen Yan
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
| | - Nasha Niu
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
| | - Yingzi Lu
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Wei Yue
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Li Pan
- Department of Nursing, Hainan Provincial Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Traditional Chinese Medicine, Haikou, Hainan 570203, China
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Zhang B, Sun J, Du Y, Shen J, Li T, Zhou Y. Treatment of Osteoarthritis Secondary to Severe Coxa Vara with Modular Total Hip Arthroplasty. Ther Clin Risk Manag 2021; 17:1199-1207. [PMID: 34824533 PMCID: PMC8610750 DOI: 10.2147/tcrm.s335015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/06/2021] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to demonstrate the methods of treatment for coxa vara with modular total hip arthroplasty (THA) and evaluate clinical and radiographic outcomes, and further survivorship at the midterm follow-up. Methods We retrospectively reviewed 33 patients (42 hips) who underwent modular THA for coxa vara deformity from May 2008 to December 2019. The clinical and radiographic results, including Harris Hip Score (HHS), leg length discrepancy (LLD), greater trochanteric height, femoral offset, abductor lever arm, stem alignment and limp, and complications, were evaluated. Results The follow-up time was mean 69.9±43.7 months. Clinically, the HHS improved significantly (p<0.001) on average from 42.90±14.44 points to 89.54±4.75 points. The mean LLD decreased from 33.3±19.4 mm to 5.0±5.8 mm (p<0.001), and 27 patients (82%) thought that total equality of the lower limbs was obtained. Patients demonstrated diminished or no limping in 88% (29/33) of hips and a significant improvement of biomechanics. At the final follow-up, all stems of hips were in clinical neutral alignment and the prostheses survivorship rates for all-causes revisions was 97.6%. Conclusion Modular THA is a valuable alternative to render favorable outcomes for treatment of osteoarthritis secondary to severe coxa vara.
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Affiliation(s)
- Bohan Zhang
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Jingyang Sun
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yinqiao Du
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
| | - Junmin Shen
- Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China.,Medical School of Nankai University, Tianjin, 300071, People's Republic of China
| | - Tiejian Li
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Yonggang Zhou
- Medical School of Chinese PLA, Beijing, 100853, People's Republic of China.,Department of Orthopedics, The First Medical Center of PLA General Hospital, Beijing, 100853, People's Republic of China.,Senior Department of Orthopedics, The Fourth Medical Center of PLA General Hospital, Beijing, 100048, People's Republic of China
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Eltit F, Noble J, Sharma M, Benam N, Haegert A, Bell RH, Simon F, Duncan CP, Garbuz DS, Greidanus NV, Masri BA, Ng TL, Wang R, Cox ME. Cobalt ions induce metabolic stress in synovial fibroblasts and secretion of cytokines/chemokines that may be diagnostic markers for adverse local tissue reactions to hip implants. Acta Biomater 2021; 131:581-594. [PMID: 34192572 DOI: 10.1016/j.actbio.2021.06.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 12/18/2022]
Abstract
Adverse local tissue reactions (ALTRs) are a prominent cause of hip implant failure. ALTRs are characterized by aseptic necrosis and leukocyte infiltration of synovial tissue. The prevalence of ALTRs in hips with failing metal implants, with highest rates occurring in patients with metal-on-metal articulations, suggests a role for CoCrMo corrosion in ALTR formation. Although hypersensitivity reactions are the most accepted etiology, the precise cellular mechanism driving ALTR pathogenesis remains enigmatic. Here we show that cobalt ions released by failing hip implants induce mitochondrial stress and cytokine secretion by synovial fibroblasts: the presumptive initiators of ALTR pathogenesis. We found that in-vitro treatment of synovial fibroblasts with cobalt, but not chromium, generated gene expression changes indicative of hypoxia and mitophagy responses also observed in ALTRs biopsies. Inflammatory factors secreted by cobalt-exposed synovial fibroblasts were among those most concentrated in ALTR synovial fluid. Furthermore, both conditioned media from cobalt-exposed synovial fibroblasts, and synovial fluid from ALTRs patients, elicit endothelial activation and monocyte migration. Finally, we identify the IL16/CTACK ratio in synovial fluid as a possible diagnostic marker of ALTRs. Our results provide evidence suggesting that metal ions induce cell stress in synovial fibroblasts that promote an inflammatory response consistent with initiating ALTR formation. STATEMENT OF SIGNIFICANCE: We demonstrate that the cytotoxic effects of cobalt ions on the synovial cells (fibroblast) is sufficient to trigger inflammation on hip joints with metal implants. Cobalt ions affect mitochondrial function, leading to the auto phagocytosis of mitochondria and trigger a hypoxic response. The cell's hypoxic response includes secretion of cytokines that are capable of trigger inflammation by activating blood vessels and enhancing leukocyte migration. Among the secreted cytokines is IL-16, which is highly concentrated in the synovial fluid of the patients with adverse local tissue reactions and could be use as diagnostic marker. In conclusion we define the cells of the hip joint as key players in triggering the adverse reactions to hip implants and providing biomarkers for early diagnosis of adverse reactions to hip implants.
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Lutz AM. Using Dual-Energy CT for Painful Hip Arthroplasties. Radiology 2021; 300:650-651. [PMID: 34227889 DOI: 10.1148/radiol.2021211272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amelie M Lutz
- From the Division of Musculoskeletal Imaging, Department of Radiology, Stanford University School of Medicine, 354 Quarry Rd, Palo Alto, CA 94304
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11
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Keller L, Hogan C, Schocket A. The role of metal patch testing in evaluating patients for metallic prosthetic joint failure. Ann Allergy Asthma Immunol 2021; 126:542-547.e1. [PMID: 33639260 DOI: 10.1016/j.anai.2021.02.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/30/2021] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Metal allergy may be an uncommon cause of prosthetic joint failure. There exist little data on patch testing to metals in this context and its impact on outcomes of joint revision in these patients. OBJECTIVE To explore the use and indications for metal patch testing in the evaluation of patients suspected of having metal allergy as a cause of failed joint replacements and to clarify the outcomes of patients revised with alternative metallic joints because of positive patch testing result. METHODS A retrospective analysis from January 2016 to April 2020 was completed on a patient cohort referred for evaluation of metal hypersensitivity. Charts were reviewed for age, biological sex, referring specialty, patch testing results, joint, revision status, and outcome measures. Biostatistical analysis and descriptive statistics were performed to determine patch testing performance and functional outcome trends among this patient cohort. RESULTS The sensitivity and specificity of patch testing, in general, are limited when evaluating patients with metallic joint replacements. However, the predictive value of testing seemed to improve with strongly positive patch testing results. Functional outcomes in patients when positive results were used to guide revision prosthesis revealed clinical improvement. CONCLUSION The attribution of metal allergy or hypersensitivity as a cause of failure in metal prosthetic joint replacement remains unproven. Some patients with positive histories and patch testing results that were used to modify the implanted prosthesis had improved functional outcomes. These results suggest that patch testing may be useful in patients with history of metal sensitivity and prosthetic failure.
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Affiliation(s)
- Levi Keller
- Internal Medicine Residency Program, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
| | - Craig Hogan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado
| | - Alan Schocket
- Division of Allergy, Asthma and Clinical Immunology, University of Colorado School of Medicine, Aurora, Colorado
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Baker E, French C, Brian P, Thomas J, Davis CM. Impending Trunnion Failure: An Uncommon Radiographic Presentation of Total Hip Arthroplasty Failure. Arthroplast Today 2021; 7:230-234. [PMID: 33614874 PMCID: PMC7878964 DOI: 10.1016/j.artd.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 01/17/2023] Open
Abstract
Trunnionosis is emerging as an early mode of failure in conventional metal-on-polyethylene total hip arthroplasty. It is defined as wear or corrosion at the trunnion, the taper at the femoral head-neck interface. Trunnion wear can result in a variety of negative sequelae and, in severe cases, necessitate revision arthroplasty. We describe a 64-year-old man with a metal-on-polyethylene total hip arthroplasty who presented with a sensation of clunking in the hip. Initial imaging and laboratory studies were inconclusive, and the decision was made to monitor. Two years later, trunnion wear was detected on radiographs, presenting as an abnormal alignment of the femoral neck relative to the femoral head. Several case reports and series describe catastrophic total hip arthroplasty failure due to trunnionosis. However, few describe the radiographic signs of wear at the trunnion before gross failure. This early presentation is important to recognize to minimize patient morbidity and aid surgical planning.
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Affiliation(s)
- Emma Baker
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
- Corresponding author. 500 University Dr, Hershey, PA 17033, USA. Tel.: +1 240 620 6937.
| | - Cristy French
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Pamela Brian
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jonelle Thomas
- Department of Radiology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Charles M. Davis
- Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
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Results of femoral neck screw fixation in 112 under 65-years-old at a minimum 2 years' follow-up. Orthop Traumatol Surg Res 2020; 106:1425-1431. [PMID: 33046434 DOI: 10.1016/j.otsr.2020.06.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/11/2020] [Accepted: 06/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Failure rates for screw fixation in femoral neck fracture in young patients are often high, with risk of aseptic femoral head osteonecrosis and non-consolidation. The present study sought to identify factors for success or failure of internal fixation according to: 1) initial treatment; 2) initial reduction quality; and 3) population characteristics. HYPOTHESIS The study hypothesis was that population, fracture type, initial treatment and reduction quality can predict survival. MATERIAL AND METHODS A retrospective study included all cases of femoral neck fracture in under 65-years-old treated by screwing in our center: i.e., 112 patients. Patient characteristics, time to surgery were collated; surviving patients were followed up at a minimum 24 months. Reduction quality was assessed on X-rays in 3 dimensions and cervico-diaphyseal angle. RESULTS Mean follow-up was 5.3±3.0 years [range, 2.0-13.6 years]. At 2 years, 23 of the 112 patients (20.5%) had developed complications: 10 osteonecroses (8.9%) and 13 non-unions (11.6%). Known hip osteonecrosis risk factors showed no significant association with survival. Failure rates were significantly higher in unstable (Garden≥3) than stable (Garden≤2) fracture: HR=2.77 [95%CI: 1.09-7.02]; p=0.025. There was no significant association with time to treatment (≤6 hours): HR=1.08 [95%CI: 0.46-2.54]; p=0.86. On 2-year radiographs, mean shortening on the z-axis was 12.3±4.8mm [-0.7 to 26.2], 8.5±5.0mm [-6.8 to 23.9] on the x-axis, and 6.4±6.1mm [-6.3 to 25.3] on the y-axis. There was a significant negative correlation between z shortening and HOOS pain component (r=-0.38; p=0.005), a non-significant negative correlation with quality of life (r=-0.20; p=0.16), and a significant negative correlation with sports activity (r=-0.28; p=0.039). CONCLUSION The present series showed lower rates of complications and of arthroplasty than in the literature. Internal fixation seemed to be indicated even at an interval of 6 hours or more. LEVEL OF EVIDENCE IV, retrospective study.
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Kim JT, Kim HS, Lee YK, Ha YC, Koo KH. Total Hip Arthroplasty With Trochanteric Ostectomy for Patients With Angular Deformity of the Proximal Femur. J Arthroplasty 2020; 35:2911-2918. [PMID: 32473769 DOI: 10.1016/j.arth.2020.04.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total hip arthroplasty (THA) of patients with a proximal femoral deformity is technically demanding. This deformity poses the risk of femoral fracture or perforation; stem malposition; and failed stem fixation. To insert a femoral stem in neutral position with a good fit, we removed the greater trochanter in case of a varus deformity, and the lesser trochanter in case of valgus deformity, while performing THA. We aimed to evaluate stem position, implant stability, clinical results, and radiological changes after THAs using this technique. METHODS Fifteen patients (17 hips; 11 varus hips and 6 valgus hips) underwent cementless THA using the trochanteric osteotomy technique in one institution. We evaluated procedure-specific complications: intraoperative femoral fracture, stem malposition, weakness of the abductor power and limp. Modified Harris Hip Score, radiological changes, and the stability of stems were assessed at a mean of 7.1 years of follow-up (range 2.0-15.5). RESULTS Femoral fracture occurred during the insertion of the stem in 4 hips. All stems were aligned in neutral position. At the latest follow-up, the mean power of the abductor was 4.3 (range 3-5). Eleven patients had slight limp and 4 patients had moderate limp. All stems had bone-ingrown stability and no stem was revised. The mean modified Harris Hip Score improved from 50 points at the preoperative evaluation to 81 points at the final follow-up. CONCLUSION The trochanteric excision enabled neutral insertion of cementless stem in patients with varus/valgus deformity of the proximal femur, and THA using this technique rendered favorable results.
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Affiliation(s)
- Jung-Taek Kim
- Department of Orthopedic Surgery, Ajou University School of Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Hong Seok Kim
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Kyung-Hoi Koo
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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