Measuring the Femoral Head Size--An Additional Real-Time Intraoperative Monitoring Tool for the Accuracy of the Preoperative Process and Implant Selection.

The purpose of this study was to examine the correlation between the implanted cup's outer diameter and the actual femoral head diameter removed during surgery. Seventy-five patients with primary total hip arthroplasty were evaluated. The difference between the implanted cup diameter and the femoral head diameter was calculated for each patient. The mean±SD actual femoral head diameter that was removed and measured during surgery was 48.5±3.7 mm. The mean±SD cementless implanted cup outer diameter was 51.8±3.5 mm. A high correlation was found between the implanted cup diameter and the actual femoral head diameter (r=0.923). A cut-off point of 4mm of the measured femoral head diameter should be considered as an additional monitoring indicator.

Supracondylar periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral replacement prosthesis.

The following study is a review of 3 different treatment methods for treating comminuted distal periprosthetic femur fractures in 23 patients over the age of 70 (average age 80, range 70-90). Reconstruction techniques included 7 allograft prosthesis composite (APC), 9 revision systems (RSA), and 7 distal femur endoprosthesis (DFR). Operative time and blood loss were found to be significantly less in RSA and DFR patients compared to the APC patients. Hospital stay was shortest for the DFR patients. No significant difference was found in the 6-week or 6-month Knee Society Scores. Our preliminary results demonstrate that in experienced hands, distal femur endoprosthesis should be considered in patients with advanced age and poor bone quality who require early mobilization.

Clinical and patient-reported outcomes of patients with four major lower extremity arthroplasties.

Few studies report the outcomes of patients treated with total joint arthroplasty of both hips and both knees. We present the outcomes of 14 patients with total joint arthroplasty of both hips and both knees using validated outcome measures. Eleven patients (79%) were satisfied at final review. Ten patients (71%) required revision surgery of at least one joint. Clinical, functional, radiographic, and patient-reported outcomes were consistent with previously reported outcomes in the literature. Mean Timed Up and Go test was 32 seconds (6-158). Mean Berg Balance Scale was 38.5 (4-55). Good outcomes can be achieved in this group of patients with high levels of satisfaction despite the frequent need for revision surgery. Importantly, it was recognized that these patients have a high risk of falls and must be educated in measures for fall prevention.

A modified cement spacer technique for infected total hip arthroplasties with significant bone loss.

Complications related to femoral spacers are common during addressing infected total hip arthroplasties by 2-stage revision. We evaluated 11 patients who had 2-stage revisions with massive bone loss after removal of the infected components by a trochanteric osteotomy. All femoral cement spacers were assembled on intramedullary nails. Femurs were protected by a plate, whereas acetabuli were augmented by a cage or roof ring depending on the remaining bone stock. This additional hardware was covered with antibiotic-impregnated cement. Infection was eradicated in 10 (90.9%) of 11 patients within 3.5 months in average. None of the patients had spacer fracture, periprosthetic fracture, or dislocation. Augmentation by hardware covered with antibiotic-impregnated cement is effective and may reduce complications until definitive treatment is performed.

Meta-analysis of unexpected findings in routine histopathology during total joint replacement.

BACKGROUND: Routine histopathological analysis of bone extracted during total joint replacement is controversial. OBJECTIVES: To evaluate the utility of routine histopathological analysis in total joint replacement. METHODS: We calculated the risk for discrepant diagnosis between the pre- and postoperative histopathological results by performing a meta-analysis of 11 studies (including our data). We also calculated the risk for significant discrepancies. RESULTS: The discrepant diagnoses analysis showed a random effect of 3% discrepancies (95% confidence interval 1.2-3.7%). Funnel plot indicates a publication bias; consequently, the conclusions from this analysis should be interpreted with caution. Regarding the significant discrepancy in diagnosis, we performed a meta-analysis of nine studies. Fixed-effects analysis of all the studies resulted in 0.16% significant discrepancies (95% CI 0.02-0.30%) with no heterogeneity (Q = 3.93, degrees of freedom = 9, P = 0.14, /2 = 49.2%), and appropriate fixed-effects models. CONCLUSIONS: We recommend no further routine histological examination, reserving this tool for cases with a controversial primary diagnosis and unexpected findings during the operation.