A Comparison of Risk of Dislocation and Cause-Specific Revision Between Direct Anterior and Posterior Approach Following Elective Cementless Total Hip Arthroplasty

BACKGROUND

Use of the direct anterior approach (DAA) for total hip arthroplasty (THA) has increased over the last decade. We sought to investigate whether (1) a difference exists in dislocation risk for DAA compared with posterior THA, (2) a difference exists in risk for specific revision reasons, and (3) the likelihood of adverse 90-day postoperative events differs.

METHODS

We conducted a cohort study using data from Kaiser Permanente's Total Joint Replacement Registry. Patients aged ≥18 years who underwent primary cementless THA for osteoarthritis with a highly cross-linked polyethylene liner were included (2009-2017). Multivariable Cox proportional hazards regression was used to evaluate dislocation and cause-specific revision risks, and multivariable logistic regression was used to evaluate 90-day emergency department visits, 90-day unplanned readmissions, and 90-day complications (including deep infection, deep vein thrombosis, and pulmonary embolism).

RESULTS

Of 38,399 primary THA, 6428 (16.7%) were DAA. All-cause revision at 2-years follow-up was 1.78% (95% confidence interval [CI] = 1.46-2.17) for DAA and 2.28% (95% CI = 2.11-2.45) for posterior. After adjusting for covariates, DAA had a lower risk of dislocation (hazard ratio [HR] = 0.39, 95% CI = 0.29-0.53), revision for instability (HR = 0.33, 95% CI = 0.18-0.58), revision for periprosthetic fracture (HR = 0.57, 95% CI = 0.34-0.96), and readmission (odds ratio = 0.82, 95% CI = 0.67-0.99) compared with posterior approach but a higher risk of revision for aseptic loosening (HR = 2.26, 95% CI = 1.35-3.79).

CONCLUSION

While the DAA associated with lower risks of dislocation and revision for instability and periprosthetic fracture, it is associated with a higher revision risk for aseptic loosening. Surgeons should discuss these risks with their patients.

The Big Thompson Flood

The Big Thompson Flood of 1976 yielded a known death toll of 139. The temporary morgue set up was successful in personally identifying all of the bodies. This effort was made possible by the fortuitous presence of the three scientists necessary for such an operation, to wit, the forensic pathologist, a forensic odontologist, and a forensic anthropologist. An outcome of the morgue effort was the establishment of the Center for Human Identification. Many law enforcement agencies and county emergency disaster offices in the country contacted the morgue directors for advice on how to cope with similar disasters. It would appear that there are no state or federal statutes or planning in the area of body identification. One function of the Center at CSU is to advise on just how a total effort in body identification can be effected.

Post-traumatic toxic shock syndrome

Toxic shock syndrome (TSS) associated with Staphylococcus occurs most commonly in menstruating women, although cases in both sexes have been reported. This report describes a severe case of TSS after a relatively minor stab wound. The male patient exhibited all of the major characteristics of this multisystem disease including anuric renal failure. TSS, which can be fatal, may result from surgical and traumatic wound infections and demands prompt recognition and treatment.

A methodology for near-optimal computational superimposition of two-dimensional digital facial photographs and three-dimensional cranial surface meshes

The authors present a methodology for human identification based on digital superimposition techniques. This methodology computes a fast, near optimal fit between a three-dimensional skull surface mesh and a two-dimensional digitized facial photograph. Since this is done digitally, (1) the photograph can be enhanced to reduce or eliminate motion blur, overexposure or underexposure, and out-of-focus distortions; (2) previous problems with skull/photograph scaling and alignment are minimized or eliminated; and (3) the photograph and skull can be numerically correlated. Two of several test cases produced from an implementation of this methodology are also presented.