Total Hip Arthroplasty For Femoral Neck Fracture : Comparing In-Hospital Mortality,Complications, and Disposition to an Elective Patient Population

Patients treated with total hip arthroplasty (THA) for osteoarthritis (OA) and femoral neck fracture (FNF) between 1990–2007 were compared using the National Hospital Discharge Survey (NHDS). In-hospital, post-operative complications and disposition were compared at six-year intervals to establish trends over time. A total of 2,160,061 THAs were performed for OA, while 174,641 were performed for FNF. Peri-operative mortality and pulmonary embolism rates following elective THA were lower at each interval when compared to THA performed for FNF (P < 0.001). Hematomas, infections, and dislocations were also higher in the traumatic group. The FNF group showed improvements with respect to mortality and rates of pulmonary embolism, infection, and dislocation over time. During the most recent interval, there was no difference in dislocation rates between the two groups. The length of stay and the percentage of patients discharging to a rehab facility were significantly higher in the FNF group at each time interval.     

Femoral Neck Fracture After Birmingham Hip Resurfacing Arthroplasty : Prevalence,Time to Fracture,and Outcome After Revision

A consecutive cohort of 3076 Birmingham Hip Resurfacings from a single institution was analyzed. The prevalence of femoral neck fracture, the time to fracture, and the outcome after revision were investigated. Fractures occurred in 34 hips (prevalence, 1.1%). Median time to fracture was 0.27 year (range, 0.014-11.2 years). Mean operation time for revision was 59 minutes, and 71% underwent isolated femoral component revision. At a mean follow-up of 5.5 years since revision, 3 patients required re-revision (2 aseptic loosening, 1 for sepsis) giving a survival of 95.7% (confidence interval, 86.9%-100%) at 5 years for the revision. Median Oxford Hip Score was 12.5% (interquartile range, 3.2%-32.3%). There were no cases of radiologic failure during follow-up. Most fractures occur early after hip resurfacing and were straightforward to revise.     

The Use of the Posterior Lesser Trochanter Line to Estimate Femoral Neck Version : An Analysis of Computed Tomography Measurements

We hypothesized that the lesser trochanter could be a useful guide for estimating femoral component version during total hip arthroplasty. We conducted a study of 88 patients to evaluate the relationship between the posterior lesser trochanter line (PLTL) and the femoral neck axis (FNA) using computed tomographic scans. The mean angle between the PLTL and the FNA was 17.4° ± 7.1° (range, −1.6° to 36.5°). The PLTL angle correlated (r² = 0.67-0.72) with the FNA angle. Intraclass correlation coefficient values showed a high level of intraobserver and interobserver agreement in the angles between the PLTL and the FNA. We found a constant relationship between the lesser trochanter and the FNA, and femoral neck version can be estimated, using the PLTL, with reasonable reliability.     

Femoral Rotation in Ligament Balanced Knee Arthroplasty : A Prospective Clinical Study

Rotational alignment of the femoral component is an important factor to achieve beneficial results in total knee arthroplasty. Femoral rotation pre versus post surgery was prospectively assessed in 40 patients who underwent ligament balanced knee arthroplasty. Computerized tomography of the knee was performed before and after the surgery to determine the femoral rotation. In 36 out of 40 patients the rotation of the femoral implants differed compared to the preoperative femur (P > 0.001). After surgery the rotational alignment of the femoral component ranged from − 3° (internal rotation) to 7° (external rotation). Increased external rotation was found in 33 out of 40 patients ranging from 1° to 7°. These results highlight the importance of individually determined femoral rotation in ligament balanced knee arthroplasty.     

A Validation Study for Estimation of Femoral Anteversion Using the Posterior Lesser Trochanter Line : An Analysis of Computed Tomography Measurement

The aim of this study was to introduce a simple and reliable intraoperative reference guide to reproduce the normal femoral anteversion during total hip arthroplasty (THA). We hypothesized that the posterior lesser trochanter line (PLTL) could be a useful guide for estimating femoral anteversion during THA. We conducted a study of 56 men (112 hips) to evaluate the relationship between the PLTL and the femoral anteversion using computed tomography scans. The mean femoral anteversion was 9.0° ± 8.1° (range, − 16.2° to 32.9°). The PLTL angle correlated (r² = 0.12, P < 0.05) with the femoral anteversion. We found a constant relationship between the PLTL and femoral anteversion, and the PLTL may be used as a guide for estimating the femoral stem anteversion during femoral stem fixation.     

Prevalence of Osteonecrosis of the Femoral Head : A Nationwide Epidemiologic Analysis in Korea

This study was performed to estimate the prevalence of osteonecrosis of the femoral head in Korea. Using medical claims data from the Korean National Health Insurance Corporation, all individuals treated under a diagnosis of osteonecrosis of the femoral head were identified for each year from 2002 to 2006. Among them, the number of true cases was estimated using a randomly collected validation sample of 382 patients for which the actual diagnosis was investigated by authors. The estimated yearly prevalence per 100 000 population ranged from 20.53 (20.13 ≤ 95% confidence interval ≤ 20.94) in 2002 to 37.96 (37.42 ≤ 95% confidence interval ≤ 38.51) in 2006. The average estimated number of annual prevalent cases was 14 103, indicating 28.91 per 100 000 average prevalence over a 5-year period. Males predominated. We found that 32.4% had history of alcohol abuse, and 14.6% was related to steroid. Bilateral involvement was noticed in 37%. Besides arthroplasty, decompression was the most frequently performed joint-preserving procedure. We believe that the results serve as important baseline for understanding the disease.     

Interprosthetic Fractures of the Femur : Treatment With a Single-Locked Plate

Interprosthetic fractures of the femur, those between an ipsilateral hip and knee arthroplasty, are challenging to treat secondary to limited bone available for fixation, osteopenic bone, a compromised intramedullary blood supply, and an often elderly patient population. From 2002 to 2006, 22 consecutive patients with an interprosthetic femur fracture were treated with a single-locking plate. Follow-up averaged 17.7 months, with fracture union achieved an average of 13.8 weeks postoperatively. All patients regained their preoperative ambulatory status and subjectively reported unchanged function of their hip and knee arthroplasties. Single-locked plating is an effective method of treatment of interprosthetic fractures of the femur. Emphasis on preservation of the soft tissue envelope and sufficient cortical purchase both above and below the fracture is of paramount importance.     

A Navigated 8-in-1 Femoral Cutting Guide for Total Knee Arthroplasty : Technical Development and Cadaveric Evaluation

The goals of this study were to determine the precision of femoral component placement using a novel computes assisted surgery (CAS)-enabled 8-in-1 cutting guide in cadaver limbs and to identify errors generated at various stages of the cutting process. The cutting guide placement was on average within 1° or millimeter of the target position in the varus/valgus, axial rotation, and cut height directions and within 2° or millimeters, in all other directions. The difference between the desired femoral component and the impacted trial component position, defined as the execution error, averaged 0.9° ± 1.7° of varus rotation, 0.8 ± 2.3 mm of lateral translation, and 0.3 ± 1 mm of proximal translation in the coronal plane (±SD). In the sagittal and axial planes, the execution error averaged 2.8° ± 2.5° of flexion, 3.4 ± 1.3 mm of anterior translation, and 0.7° ± 2.7° of external rotation. CAS permits accurate placement of 8-in-1 jigs for valgus/varus, axial rotation, and cut height but is less accurate in the sagittal plane. Care should be taken when executing the cuts, which can affect precision in the sagittal plane more than actual positioning of the jig.     

One-Stage Total Knee Arthroplasty With Pre-Existing Fracture Deformity : Post-Fracture Total Knee Arthroplasty

The aim of the study was to assess the results of treating knee osteoarthrosis with total knee arthroplasty (TKA) after previous tibia and/or femur fractures resulting in axial limb deformities. Thirty-six knees (34 patients) were operated on. At the most recent follow-up, 4.8 years after surgery, all but one patient demonstrated an improvement in both clinical and functional KSS. This male patient required revision after 2 years. Improved range of motion was generally noted, especially extension, however, two patients with both tibia and femur fractures had worse results. TKA is an effective method of treatment for patients with arthrosis after a previous femur or tibia fractures. When deformity is severe semi-constrained or constrained, implants with extensions may be necessary.     

Squeaking Hip Arthroplasties : A Tribological Phenomenon

The clinical incidence of squeaking has been reported with increasing frequency, with ceramic-on-ceramic bearings seemingly most affected. This study investigated potential causes of squeaking in hard-on-hard hip bearings through 2 sets of experimental conditions. Bearing clearance appeared to affect the incidence of squeaking in metal-on-metal surface arthroplasties. The addition of third-body particles to the interface for total hip arthroplasties also affected the incidence of squeaking. In both studies, the incidence of squeaking correlated well with elevated friction. The findings of this study suggest that a likely cause of squeaking in the hip arthroplasty is adverse tribological conditions caused by suboptimal lubrication. There are numerous factors that may cause the suboptimal lubrication, and therefore, it is unlikely that an individual cause for squeaking will be identified.     

Joint Replacement Access in 2016 : A Supply Side Crisis

Demand for primary and revision arthroplasty is expected to double in 10 years. Coincident with this is a decreased interest in arthroplasty by residents. Retirement of arthroplasty surgeons further threatens access. This study determines if supply will meet demand. Survey data were used to calculate the 2016 workforce. Demand in 2016 was estimated using the Nationwide Inpatients Sample. Between 2008 and 2016, 400 arthroplasty specialists and 1584 generalists will enter the workforce. By 2016, 1896 arthroplasty surgeons will retire using 65 years as a conservative retirement age, whereas 4239 will retire using 59 years as a baseline retirement age. In 2016, the model estimated a procedural shortfall ranging from 174?409 (↓18.6%) using conservative retirement assumptions (age, 65 years) to 1?177?761 (↓69.4%) using baseline retirement assumptions (age, 59 years). This economic model predicts a supply side crisis that threatens patient access to specialty care. Immediate steps to stimulate supply must be taken.     

同侧股骨干合并股骨颈骨折的手术治疗

目的探讨同侧股骨干合并股骨颈骨折的临床特点及治疗方法。方法选择2000年2月至2006年4月,14例经手术复位内固定治疗的同侧股骨干合并股骨颈骨折患者进行回顾性分析,其中股骨颈骨折漏诊4例,采用股骨重建髓内钉固定4例,股骨逆行交锁髓内钉及空心螺钉固定5例,股骨交锁髓内钉结合空心螺钉固定2例,股骨干骨折加压钢板及空心钉固定3例。结果本组14例均获随防,随访时间为12~48个月,平均27个月。14例股骨干骨折均在术后7个月内获得愈合,股骨颈骨折在6个月内愈合。无切口感染、血管神经损伤、内固定断裂及股骨头缺血性坏死等并发症发生。所有患者髋关节功能的恢复无活动障碍,膝关节活动受限1例。结论同侧股骨干合并股骨颈骨折时股骨颈骨折常常无移位或轻度移位,其漏诊率高,在骨折治疗的微创理念指导下,运用医生熟练掌握的内固定方法,经过合理的术后功能锻炼,可获得满意的临床疗效。     

The Boiled-Egg Technique : A New Method for Obtaining Femoral Head Autograft Used in Acetabular Defect Reconstruction

Primary total hip arthroplasty can be complicated by acetabular bony defects, threatening the biomechanical integrity of the prosthesis. Traditionally, when autologous bone is used to pack these defects, it is obtained from thin slices of femoral head in addition to acetabular reamings. We report a novel technique for the acquisition of autologous femoral head bone graft used in the reconstruction of acetabular defects during primary total hip arthroplasty.     

Publication Trends in Knee Surgery : A Review of the Last 16 Years

The trends in the publication of articles regarding knee arthroplasty and soft tissue surgery were analysed with regard to geographical authorship, institutional funding and number of authors. Over 7500 articles from relevant journals with the highest impact factors according to the Thomson Reuters Journal Citation Report (2010) were evaluated from 1995 to 2010. The rate of publication increased by 16.9 per year for arthroplasty articles and by 13.9 per year for soft tissue surgery articles. The relative supremacy of the USA has declined over the 16 years, its share dropping from 72.2% to 39.2% for arthroplasty articles and from 61.7% to 36.6% for soft tissue surgery articles. The UK, Japan, South Korea and smaller countries in Asia and South America have become increasingly prolific.     

Primitive Results After Medial-Pivot Knee Arthroplasties : A Minimum 5-Year Follow-Up Study

Paradoxical anterior movement of the femoral condyles after total knee arthroplasty (TKA) often attenuates the extension mechanism and causes a suboptimal outcome. The medial-pivot implant design aimed to confine anterior movement and emulate physiologic knee kinematics. In our study, a consecutive series of 58 medial-pivot TKA were enrolled with a minimum 5-year follow-up. The Knee Society score improved from 30.5 to 91.1 in objective and from 36.7 to 82.3 in functional scale. The average range of motion was 115.4°. The medial-pivot TKA provided significant improvement in the postoperative range of motion, objective Knee Society score, pain scale, and functional score (P < .05) statistically. A larger sample and longer follow-up are recommended to draw definitive conclusions of this new implant design.     

Bilateral Total Joint Arthroplasty : The Early Results from the New Zealand National Joint Registry

This study evaluated the mortality rate, major complications, and early outcomes of single anesthetic bilateral total hip and knee arthroplasty compared with unilateral and staged procedures. A total of 37 828 total hip and knee arthroplasties were evaluated with 6-month Oxford 12 scores. Major complications and mortality rates were recorded. Analysis of variance tables were used for statistical analysis. The single anesthetic bilateral group were significantly younger (P < .001), with their age-adjusted postoperative Oxford 12 scores significantly better (P < .001) than the other 2 groups. The surgeons involved, in general, performed more than 25 total knee and hip arthroplasties per year. There was 1 death within the first 6 months occurring in the staged bilateral group and was unrelated to the surgery. The complication rate as reported by patients was low in all groups, and there was no significant difference. The results show that, in selected patients, single anesthetic bilateral total knee or hip arthroplasty is a safe, low-risk procedure with very good patient-generated outcome scores at 6 months when performed by an experienced surgeon.