Retroperitoneal hematoma: an unusual cause of pain after total hip arthroplasty

Pain following total hip arthroplasty due to impingement of the iliopsoas is a recognized complication of the procedure with a reported incidence as high as 4.3%. The pain is most often due to direct mechanical irritation of the iliopsoas due to a malpositioned or oversized acetabular cup. Definitive treatment of iliopsoas impingement often requires surgical revision or iliopsoas tenotomy, although many cases remain undiagnosed or are managed conservatively. We present an unusual case of pain after total hip arthroplasty due to a large retroperitoneal hematoma secondary to acetabular cup irritation of the iliopsoas tendon. This case represents a potentially important complication of undiagnosed or conservatively managed iliopsoas impingement, particularly in patients taking anticoagulants or antiplatelet medications.     

An unusual cause of thigh pain after total hip arthroplasty

The aim of total hip arthroplasty surgery is to relieve pain. There are many postulated causes of thigh pain following total hip arthroplasty, some of which are not easily corrected. Muscle hernia as a result of hip surgery is a cause of thigh pain that is disabling, relatively easy to diagnose, and may be preventable.     

Intraoperative estimation of femoral anteversion in cementless total hip arthroplasty using the lesser trochanter

Introduction  

The intraoperative estimation of the anteversion of the femoral component of a total hip arthroplasty is generally made by the surgeon’s visual assessment of the stem position relative to the condylar plane of the femur.     

Synovial metastasis: an unusual cause of pain after total knee arthroplasty

There is only 1 previous report of synovial metastasis to a joint that has been replaced. A 73-year-old man presented for investigation of continuing pain after a left total knee arthroplasty with normal plain radiographs. Synovial biopsy revealed metastatic adenocarcinoma of colorectal type. A barium enema and flexible sigmoidoscopy showed a suspicious lesion at the rectosigmoid junction. The knee is the most frequently affected joint, and the lung is the most common primary site for synovial metastasis. This phenomenon should be considered in the differential diagnosis of continuing pain and effusion postarthroplasty.     

Fractures through cystic lesions of the greater trochanter: A cause of late pain after cementless total hip arthroplasty

Four patients who presented with sudden onset of hip pain 7 to 11 years after successful porous-coated cementless hip arthroplasty are described. These four patients were all diagnosed to have fractures through osteolytic cysts in the greater trochanter. One patient was seen initially with a displaced fracture of the greater trochanter. Two patients were treated operatively with curettage of the cystic area and with polyethylene exchange. One of these patients underwent revision of the femoral component in addition to the polyethylene exchange. Two patients were treated nonoperatively. The fractures treated nonoperatively have healed and the patients have resumed their normal activities. This report should stimulate an awareness of fractures through cystic lesions of the greater trochanter as a late cause of hip pain after porous-coated cementless hip arthroplasty.     

Iliopsoas tendon dysfunction as a cause of pain after total hip arthroplasty relieved by surgical release

Pain after total hip arthroplasty (THA) may be due to a number of factors, including dysfunction of the iliopsoas tendon. We report a case of persistent groin pain after THA. The pain was successfully treated using iliopsoas tenotomy rather than revision of any prosthetic component.     

Rupture of the quadriceps tendon after total knee arthroplasty: A case report

Reported herein is the case of a 45-year-old woman with knee involvement due to rheumatoid arthritis. She had a total knee arthroplasty with a rupture of the quadriceps tendon 1 month later. Surgical repair of the rupture was performed following the Scuderi technique plus reinforcement with Dacron (Lig Aid, Levallois, Cedex. France) tape cerclage. An above-knee walking-plaster cast was applied with the knee in full extension for 6 weeks. The functional result was good 1 year after surgery.     

Recurrent dislocation of total knee arthroplasty: an unusual cause

We report an unusual case of recurrent dislocation of posterior stabilized total knee arthroplasty (TKA) secondary to fracture of the polyethylene insert. Recurrent dislocation occurred 21 months after primary TKA. Fractured polyethylene insert was noted as an abnormal radiolucent shadow on postoperative radiographs and was confirmed by an arthrogram. At revision surgery, disintegration of the insert, including the tibial post, was found. We recommend careful scrutiny of the integrity of the polyethylene insert at the time of follow-up evaluation in cases of TKA dislocation.     

Avulsion fracture of the ischium following complex total hip arthroplasty: An unusual cause of hip pain

Total hip arthroplasty in the high riding dislocated hip is a technically difficult undertaking, with major reconstruction required on both the acetabular and femoral sides. With reconstruction at a near-anatomic hip center, reduction of the arthroplasty is difficult because of the long-standing limb shortening. The major block to reduction is tension of the soft tissues, particularly the hamstrings. We report a case of ischial tuberosity avulsion fracture following such a complex reconstruction despite femoral shortening subtrochanteric osteotomy. This illustrates the importance of the hamstring group in maintaining the dislocation and emphasizes the need to prevent overtension of the soft tissues in such complex reconstructive procedures.     

Claw plate fixation of the greater trochanter in revision total hip arthroplasty

The purpose of this retrospective study was to evaluate a new trochanteric claw plate for trochanteric fixation. From 1998 to 2004, 31 procedures were performed by one surgeon. Mean follow-up was 2.2 years. Indications for the procedure included 16 nonunion, 7 trochanteric osteotomy, 5 periprosthetic fractures, and 3 intraoperative fractures. Median Harris hip scores improved from 47 to 92 points (P < .0001). No patient had an abductor lurch postoperatively (P < .0001). No patient had moderate or severe pain postoperatively (P < .0001). Median active abduction increased from 0 degrees to 25 degrees (P < .0001). Osseous union occurred in 28 of 31 hips. Plate-related complications occurred in 6 of 31 hips. No significant difference was identified for outcomes based on indication. In conclusion, the claw plate in this study can sufficiently treat the complex situation of trochanteric nonunion, fracture, or osteotomy.     

Pelvic pseudotumor: an unusual presentation of an extra-articular granuloma in a well-fixed total hip arthroplasty

A 76-year-old woman developed a pelvic mass and abdominal pain 12 years after cementless total hip arthroplasty. The mass was a cystic granuloma that communicated with the hip joint via a soft tissue herniation under the inguinal ligament. There was no acetabular lysis or defects. The shell and femoral component were well fixed, the polyethylene was worn, and a liner exchange was undertaken. The cyst was debrided, and follow-up computed tomography demonstrated resolution of the granuloma and no recurrence of the cyst. Removal of the source of the particle wear debris via liner exchange or revision surgery combined with cyst debridement via a single incision is recommended.     

Late symptoms after hip fracture with displacement of the lesser trochanter - a case report

No Abstract available     

Late symptoms after hip fracture with displacement of the lesser trochanter - a case report

No Abstract available     

Periprosthetic malignancy as a mode of failure in total hip arthroplasty

The presence of periprosthetic malignancy in proximity to arthroplasty implants has been infrequently reported. We present the clinical, radiographic, and pathological features of three patients in whom loosening and failure of total hip arthroplasties occurred secondary to malignant infiltration. They consisted of a 66-year-old man with the first presentation of metastatic gastric carcinoma as a periacetabular lytic lesion, a 64-year-old man presenting with femoral metastases from a previously undiagnosed lung carcinoma, and a 75-year-old woman presenting with a painless discharging thigh sinus around a total hip arthroplasty subsequently diagnosed as immunoblastic lymphoma. Malignant infiltration should be considered part of the differential diagnosis in aseptic and septic loosening of prosthetic implants. Joint aspiration and isotope bone scanning provide useful additional information before surgical intervention.     

Citrobacter koseri as a cause of early periprosthetic infection after primary total hip arthroplasty

Periprosthetic joint infection in the acute setting is usually caused by gram-positive species and remains a major problem facing total joint surgeons. We report a case of a 53-year-old male who presented with drainage 3 weeks after primary total hip arthroplasty. Citrobacter koseri was cultured from an infected hematoma in his deep tissues. Surgical treatment included irrigation and debridement with femoral head and liner exchange. He received a 6-week course of ertapenem and is currently asymptomatic. We present C. koseri as a rare cause of acute periprosthetic infection and offer an effective treatment protocol.     

Bisphosphonate fractures as a cause of painful total hip arthroplasty

Osteoporotic fractures pose a significant health concern for postmenopausal women. Bisphosphonate therapy has been shown to decrease the risk of these fractures. The bisphosphonate alendronate was approved by the US Food and Drug Administration for use in the United States in 1995, but questions have recently arisen concerning low-energy subtrochanteric femur fractures sustained by chronic users. Although no definitive association or causality between bisphosphonates and these fractures has been established, numerous cautionary reports exist concerning the duration of use and safety of alendronate in osteoporotic patients. This article reports 3 occurrences of bisphosphonate-associated atypical femur fractures as an etiology of periprosthetic hip pain in the total hip arthroplasty (THA) patient. These fractures are particularly concerning because these patients are often not advised to protect their weight bearing simply due to a painful THA and may sustain a catastrophic failure if not followed closely. Several theories have been suggested concerning the pathophysiology of atypical low-energy subtrochanteric fractures following bisphosphonate use. Each patient described in this article carried a diagnosis of rheumatoid arthritis and underwent chronic medical therapy; each patient experienced a delay in the diagnosis and onset of therapy due to low suspicion for bisphosphonate-associated fracture. This problem may become more common in the clinical setting; therefore, one must be vigilant and aware of this etiology of periprosthetic hip pain.     

Greater trochanter chip fractures in the direct anterior approach for total hip arthroplasty

Background

The direct anterior approach (DAA) for the treatment of total hip arthroplasty (THA) has gained popularity in recent years. Chip fractures of the greater trochanter are frequently seen, but the risk factors for such fractures are unknown. The study aimed to identify the risk factors for chip fractures in patients undergoing primary THA by the DAA during the surgeons’ learning curve.

Materials and methods

From November 2011 to April 2015, the first experiences of three surgeons who performed 120 THAs by the DAA (120 hips; 40 cases per beginner surgeon) were included. The incidence of chip fracture of the greater trochanter, the size of the greater trochanter as measured by computed tomography, and the patients’ characteristics were retrospectively investigated.

Results

After exclusion of 11 hips, the remaining 109 hips were investigated. Chip fracture of the greater trochanter was identified in 32 hips (29.4 %). Univariate analysis with and without fractures showed that the width and depth of the greater trochanter were statistically significant risk factors (p = 0.02 and p < 0.001, respectively). Multivariate analysis using a logistic regression model demonstrated that the depth of the greater trochanter was an independent risk factor for chip fracture of the greater trochanter (OR 1.725; 95 % CI 1.367–2.177; p < 0.001).

Conclusion

The size of the greater trochanter was identified as a risk factor for chip fracture of the greater trochanter. Novice surgeons should pay attention to the size of the greater trochanter when performing THA by the DAA.