Clinical orthopaedics and related research
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Clin. Orthop. Relat. Res. · Feb 2014
Multicenter StudyHigh survivorship with a titanium-encased alumina ceramic bearing for total hip arthroplasty.
Although ceramic-on-ceramic bearings for total hip arthroplasty (THA) show promising results in terms of bearing-surface wear, fracture of the bearing, insertional chips, and squeaking remain a concern. ⋯ Ceramic bearings for THA with a titanium-encased insert have high survivorship at 10 years followup and a fracture risk of 0.5%. We found at last followup on routine radiographs no evidence of osteolysis, and no patient has been revised for squeaking or has reported dissatisfaction with the clinical result because of noise. IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Clin. Orthop. Relat. Res. · Feb 2014
Randomized Controlled TrialThe effect of infrapatellar fat pad excision on complications after minimally invasive TKA: a randomized controlled trial.
The infrapatellar fat pad is one of the structures that obscures exposure in minimally invasive total knee arthroplasty (MIS TKA). Most MIS TKA surgeons (and many surgeons who use other approaches as well) excise the fat pad for better exposure of the knee. There is still controversy about the result of fat pad excision on patella baja, pain, and function. ⋯ Infrapatellar fat pad excision in MIS TKA resulted in an increasing small percentage of patients with anterior knee pain after surgery. Surgeons should keep the fat pad if excellent exposure can be achieved but resect it if needed to improve exposure during TKA.
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Clin. Orthop. Relat. Res. · Feb 2014
Tapered fluted titanium stems in the management of Vancouver B2 and B3 periprosthetic femoral fractures.
Surgeons have several implant choices when managing Vancouver B2 and B3 periprosthetic fractures about the hip. Few long-term studies have reported outcomes for tapered fluted titanium stems. ⋯ We report encouraging short-term results in terms of survival of distal taper stems in the treatment of B2 and B3 periprosthetic fractures. Although subsidence was frequent, most migrated less than 3 mm without correlation to poor pain and functional scores.
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Clin. Orthop. Relat. Res. · Feb 2014
Coexisting lumbar spondylosis in patients undergoing TKA: how common and how serious?
Information on the coexistence of lumbar spondylosis and its influence on overall levels of pain and function in patients with advanced knee osteoarthritis (OA) undergoing total knee arthroplasty (TKA) would be valuable for patient consultation and management. ⋯ Radiographic lumbar spine degeneration and lumbar spine symptoms are common among patients with advanced knee OA undergoing TKA. Severe lumbar spine symptoms (visual analog scale score of ≥ 7) were likely to adversely affect the preoperative clinical scores of patients undergoing TKA; however, most of the adverse effects were not found 2 years after TKA. Nevertheless, because preexisting severe radiating pain during activity may be a source of a poorer outcome after TKA, careful patient consultation regarding this potential poorer prognosis after TKA needs to be provided to the patient with this symptom.
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Clin. Orthop. Relat. Res. · Feb 2014
What causes unexplained pain in patients with metal-on metal hip devices? A retrieval, histologic, and imaging analysis.
Adverse tissue reactions associated with metal-on-metal (MOM) hips are common in resurfacing and total hip arthroplasty (THA) designs. The etiology of these reactions in painful, well-positioned arthroplasties is inconsistently described. ⋯ Unexplained pain in patients with well-positioned MOM hips warrants further investigation with MRI to look for features predictive of ALVAL. Tissue destruction in these cases does not appear to be related to high bearing wear or the presence of a taper.