Bulletin of the NYU hospital for joint diseases
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Bull NYU Hosp Jt Dis · Jan 2011
ReviewAdverse soft-tissue reactions around non-metal-on-metal total hip arthroplasty - a systematic review of the literature.
Adverse local soft-tissue reactions have been associated with severe osteolysis and implant failure in metal-on-metal total hip arthroplasty (THA). Such a causal relationship has not often been associated with non metal-on-metal bearing surfaces. The purpose of this study was to assess the literature for cases of adverse soft-tissue reactions in non-metal-on-metal bearings in order to determine if a consistent histological diagnosis existed and if it was bearing-specific. ⋯ The present analysis revealed that similar adverse soft-tissue reactions have been described for both metal-on-polyethylene and ceramic bearing surfaces. When encountering such reactions in patients, a comprehensive diagnostic workup, including computed tomography (CT) scanning, lesion biopsy, and revision planning to alternate bearing surfaces should be considered.
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Bull NYU Hosp Jt Dis · Jan 2011
Comparative StudyThe outcomes of Cormet hip resurfacing compared to standard primary total hip arthroplasty.
Metal-on-metal hip resurfacing has provided an alternative to standard total hip arthroplasty in younger, more active patients. However, detractors argue that many of the benefits of resurfacing can be obtained with the use of larger femoral heads. The purported advantages of the resurfacing procedure include preservation of femoral bone stock, increased range of motion, decreased dislocation rate, excellent performance in high-activity patients, and a potentially easier revision than total hip arthroplasty. The purpose of this study was to examine the outcomes of patients who had hip resurfacing and to compare them to all total hip arthroplasty procedures performed during the same time period. ⋯ Excellent results continue to be demonstrated with hip resurfacing systems, with equal, early survivorship when compared to total hip arthroplasty. For patients who meet the appropriate selection criteria and in the hands of an experienced, high-volume arthroplasty surgeon hip resurfacing provides excellent early results.
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Bull NYU Hosp Jt Dis · Jan 2011
Case ReportsIsolated Hoffa fracture of the medial femoral condyle in a skeletally immature patient.
Intraarticular coronal fracture of the femoral condyle is rare, and an isolated medial Hoffa fracture in a child is extremely rare. To our knowledge, such a case has not yet been reported in the literature. Early diagnosis and prompt treatment are essential for a good long-term outcome. ⋯ At the 36-month follow-up, the fracture was united, and the patient had full extension and approximately 130° flexion of knee. There was no varus or valgus instability or limb length discrepancy. This case highlights the importance of early diagnosis and prompt treatment in the form of epiphyseal fixation for the management of these fractures in skeletally immature individuals.
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Bull NYU Hosp Jt Dis · Jan 2011
Outcomes analysis of anterior-posterior fusion for low grade isthmic spondylolisthesis.
Traditional surgical treatment of isthmic spondylolisthesis is posterior-lateral fusion, but the addition of anterior surgery has been explored. The purpose of this study was to evaluate the surgical and clinical outcomes of anterior-posterior surgical treatment for low-grade isthmic spondylolisthesis. ⋯ In our study, patients demonstrated an improvement in the ODI as well the physical component scores of the SF-36, thus having a good clinical outcome.
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Bull NYU Hosp Jt Dis · Jan 2011
Correlation between nutritional status and Staphylococcus colonization in hip and knee replacement patients.
Orthopaedic patients with poor nutritional status are at an increased risk of postoperative complications, such as infection and wound healing. Nasal colonization with Staphylococcus aureus, especially with methicillin-resistant Staphylococcus aureus, has been shown to be a risk factor for surgical-site infections. We examined the incidence of nutritional depletion in our arthroplasty population and its correlation with Staphylococcus aureus colonization. ⋯ Six hundred and fifty-two patients underwent arthroplasty and completed preoperative nasal cultures and nutritional assessment. A high percentage (27%) of our patients demonstrated some level of nutritional depletion prior to joint replacement. Overall nutritional scores were not significantly associated with surgery-type, preoperative nasal culture, or surgical- site infection in our patient population.