ABSTRACT
More than half of sciatic nerve palsies after primary total hip arthroplasties are unexplained. In 2 such cases, magnetic resonance imaging localized compressive injury between the ischial tuberosity and femoral insertion of the gluteus maximus. After these cases, we hypothesized that during limb positioning, the sciatic nerve is compressed by the gluteus maximus tendon. We present the magnetic resonance imaging findings from these 2 cases and compare the number of sciatic nerve palsies in patients with release of the gluteus maximus tendon to patients without release during primary total hip arthroplasty. There were no cases of sciatic nerve palsy when the gluteus maximus was released, compared with 3 cases in the control group.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Sciatic Neuropathy/etiology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Risk Factors , Sciatic Neuropathy/diagnosisABSTRACT
This prospective randomized double-blind study aims to evaluate the effect of surface finish of the cemented femoral stem in primary total hip arthroplasty. Between January 1996 and May 1997, a single surgeon prospectively implanted 244 primary THAs (237 patients) using cemented femoral stems with modified third-generation cement technique in selected patients. Patients were randomized to receive the Ranawat-Burstein prosthesis (Biomet, Warsaw, IN) with 1 of 2 finishes (smooth-Ra 17 or rough-Ra 170). At a minimum 5-year follow-up, no statistical differences were found between the 2 groups. One patient with a smooth stem underwent revision of the femoral component at 2 years secondary to aseptic loosening. There was no other evidence of radiographic loosening or osteolysis. As an isolated variable, surface finish does not appear to significantly influence results at mean follow-up of 6.5 years.
Subject(s)
Arthroplasty, Replacement, Hip/methods , Cementation , Hip Prosthesis , Aged , Aged, 80 and over , Chi-Square Distribution , Coated Materials, Biocompatible , Double-Blind Method , Female , Femur , Follow-Up Studies , Hip Joint/diagnostic imaging , Humans , Male , Middle Aged , Prospective Studies , Prosthesis Design , Prosthesis Failure , Radiography , Surface Properties , Treatment OutcomeABSTRACT
This prospective review aimed to evaluate 15-year survivorship of the collarless, third-generation cemented, normalized, Omnifit (Osteonics, Allendale, NJ) femoral stem in hybrid total hip arthroplasty (THA). Between January 1986 and June 1990, a single surgeon prospectively implanted 250 consecutive hybrid THAs (215 patients) using a modified third-generation cement technique in selected patients. A Harris-Galante (I or II) (Zimmer, Warsaw, IN) cementless shell with modular polyethylene (4150 resin) liners gamma-sterilized in air were implanted. Kaplan-Meier survivorship of the femoral or acetabular component with mechanical failure (revision for aseptic loosening) as the end-point was 100% +/- 0% at 15 years. Wear couple exchange and bone grafting was performed in 1 case (0.4%) for progressive acetabular osteolysis. This report supports femoral component centralization and good cement mantle to ensure durability of the collarless, cemented, normalized femoral stem with a surface roughness of 30-40 microinches.
