Survivorship analysis of total hip replacements. Results in a series of active patients who were less than fifty-five years old

Between 1971 and 1980, the senior one of us (C.S.R.) performed 101 primary total hip replacements in eighty-five consecutive patients who were less than fifty-five years old. All of the patients had degenerative joint disease. Survivorship analysis was used to calculate a predicted cumulative rate of success for this series of total hip replacements over ten years of follow-up. This method of analysis of the data was chosen because it provides a prediction of the expected durability of a total hip arthroplasty in any individual patient. The need for revision because of loosening or infection or else radiographic evidence of migration of a component was the criterion for failure. Two revisions were performed for aseptic loosening of the acetabular component. One infection necessitated revision, and radiographic evidence of loss of fixation was seen in one additional acetabular component and one femoral stem. Life-table calculations predicted that the survivorship of all of the total hip replacements in this series would be 87.6 per cent at ten years of follow-up. Based on the results of the application of this method of analysis to the current series, we concluded that a primary cemented total hip replacement, when performed for coxarthrosis, can be expected to function durably in an active middle-aged patient.     

Wear Rates With Large Metal and Ceramic Heads on a Second Generation Highly Cross-Linked Polyethylene at Mean 6-Year Follow-Up

Background

Bearing surface wear and osteolysis are major factors limiting the durability of total hip arthroplasty (THA). Second generation annealed highly cross-linked polyethylene (HXLPE) and ceramics were introduced to THA for their excellent wear rates. However, there is little data comparing the wear rates of metal and ceramic heads on second generation HXLPE.

The Risk of Direct Peroneal Nerve Injury Using the Ranawat “Inside-Out” Lateral Release Technique in Valgus Total Knee Arthroplasty

The purposes of our study are to define a “danger zone” and a “safe zone” to avoid common peroneal nerve direct injury performing the “inside-out” release technique of posterior-lateral corner during total knee arthroplasty and to identify anatomic landmarks to localize the nerve before the soft-tissues release. Twenty cadaver dissections were used for testing. The distance from the nerve to the posterior-lateral corner of the tibia and to the posterior border of the iliotibial band averaged, respectively, 13.5 and 35.8 mm. The nerve is at risk during the release of the posterior-lateral capsule, in the triangle defined by the popliteus tendon, the tibial cut surface, and the most posterior fibers of iliotibial band (danger zone), but not during pie-crusting of the iliotibial band (safe zone).     

Magnetic resonance imaging in the diagnosis and management of hip pain after total hip arthroplasty

Evaluation of pain following total hip arthroplasty (THA) can be challenging in the absence of radiographic pathology. This study aimed to examine the diagnostic utility of magnetic resonance imaging (MRI) in the evaluation of enigmatic hip pain following THA. We reviewed a series of patients who were evaluated with MRI after presenting with enigmatic hip pain following THA. MRI was able to demonstrate pathology in the periprosthetic tissues in all hips with minimal artifact. Patients underwent a range of conservative and operative interventions depending on the underlying pathology. If used discriminately in situations where pathology cannot be detected by conventional methods, MRI is a highly effective modality that can aid in the diagnosis of a wide range of disorders thereby allowing the clinician to determine the most appropriate intervention.     

Material Properties of Fresh Cold-stored Allografts for Osteochondral Defects at 1 Year

Little is known about the long-term properties of fresh cold-stored osteochondral allograft tissue. We hypothesized fresh cold-stored tissue would yield superior material properties in an in vivo ovine model compared to those using freeze-thawed acellular grafts. In addition, we speculated that a long storage time would yield less successful grafts. We created 10-mm defects in medial femoral condyles of 20 sheep. Defects were reconstructed with allograft plugs stored at 4°C for 1, 14, and 42 days; control specimens were freeze-thawed or defect-only. At 52 weeks, animals were euthanized and retrieved grafts were analyzed for cell viability, gross morphology, histologic grade, and biomechanical and biochemical analysis. Explanted cold-stored tissue had superior histologic scores over freeze-thawed and defect-only grafts. Specimens stored for 1 and 42 days had higher equilibrium moduli and proteoglycan content than freeze-thawed specimens. We observed no difference among any of the cold-stored specimens for chondrocyte viability, histology, equilibrium aggregate modulus, proteoglycan content, or hypotonic swelling. Reconstructing cartilage defects with cold-stored allograft resulted in superior histologic and biomechanical properties compared with acellular freeze-thawed specimens; however, storage time did not appear to be a critical factor in the success of the transplanted allograft. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution has approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.     

A randomized, parallel-group, open-label trial of recombinant human erythropoietin vs preoperative autologous donation in primary total joint arthroplasty: effect on postoperative vigor and handgrip strength

This randomized trial assessed the effect of recombinant human erythropoietin (EPO) vs preoperative autologous donation (PAD) on postoperative vigor and handgrip strength in patients undergoing primary total joint arthroplasty. Adults with baseline hemoglobin level of 11 to 14 g/dL received EPO (600 IU/kg once weekly for 4 doses, n = 130) or PAD (n = 121) before primary, unilateral hip or knee arthroplasty. Mean changes in vigor score and handgrip strength from baseline were not significantly different between treatment groups. Multivariate analyses found a significant treatment effect favoring EPO over PAD for vigor, but not for handgrip strength. Patients in the EPO group had higher hemoglobin levels and required fewer transfusions. Both treatments were well tolerated. Additional study is needed to elucidate the influence of blood management strategies on postoperative vigor.