ABSTRACT
BACKGROUND: Epidemiological estimates indicate a rising incidence of periprosthetic hip fractures. While native hip fractures are known to be a highly morbid condition, a significant body of research has led to improved outcomes and decreased complications following these injuries. Comparatively, little research has evaluated the relative morbidity and mortality of periprosthetic hip fractures. The purpose of this study was to compare the morbidity and mortality of periprosthetic vs native hip fractures. METHODS: Using the National Surgical Quality Improvement Program (NSQIP) database, 523 periprosthetic hip fractures were matched to native hip fractures using propensity scores. The 30-day rates of complications were compared using McNemar's test. A multivariate regression was then used to determine independent risk factors for mortality following periprosthetic fracture. RESULTS: Mortality was similar between groups (periprosthetic: 2.7% vs native: 3.4%; P = .49). Periprosthetic fractures exhibited a greater rate of overall (63.1% vs 38.6%; P < .001) and minor complications (59.1% vs 34.4%; P < .001). There was an increased rate of return to the operating room (7.8% vs 3.1%; P < .001) and blood transfusion in the periprosthetic group (54.9% vs 30.2%; P = .001). Age greater than 85 (odds ratio 9.21) and dependent functional status (odds ratio 5.38) were both independent risk factors for mortality following periprosthetic fracture. CONCLUSIONS: While native hip fractures are known to be highly morbid, our findings suggest that periprosthetic hip fractures have a similar mortality with significantly higher short-term morbidity. Future research is warranted to better understand risk factors and prevention strategies for complications in this subset of patients.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/mortality , Hip Fractures/epidemiology , Hip Fractures/mortality , Periprosthetic Fractures/epidemiology , Periprosthetic Fractures/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Body Mass Index , Data Collection , Databases, Factual , Female , Femoral Fractures/epidemiology , Femoral Fractures/mortality , Humans , Length of Stay , Male , Middle Aged , Odds Ratio , Operating Rooms , Patient Readmission , Propensity Score , Quality Improvement , Quality of Health Care , Retrospective Studies , Risk Factors , Young AdultABSTRACT
BACKGROUND: In revision total hip arthroplasty (THA), proximal femoral bone loss creates a challenge of achieving adequate stem fixation. The purpose of this study was to examine the outcomes of a monoblock, splined, tapered femoral stem in revision THA. METHODS: Outcomes of revision THA using a nonmodular, splined, tapered femoral stem from a single surgeon were reviewed. With a minimum of 2-year follow-up, there were 68 cases (67 patients). Paprosky classification was 3A or greater in 85% of the cases. Preoperative and postoperative Harris Hip Scores (HHS), radiographic subsidence and osseointegration, limb length discrepancy, complications, and reoperations were analyzed. RESULTS: The Harris Hip Score improved from 37.4 ± SD 19.4 preoperatively to 64.6 ± SD 21.8 at final follow-up (P < .001). There were 16 revision procedures-8 for septic indications and 8 for aseptic indications. Subsidence occurred at a rate of 3.0% and dislocation at 7.4%. Limb length discrepancy of more than 1 cm after revision was noted in 13.6% of patients. Bone ingrowth was observed in all but 4 patients (94.1%). At 4-year follow-up, Kaplan-Meier estimated survival was 72.9% (95% confidence interval [CI] 57.0-83.8) for all causes of revision, 86.6% (95% CI 72.0-93.9) for all aseptic revision, and 95.5% (95% CI 86.8-98.5) for aseptic femoral revision. CONCLUSION: Although complications were significant, revision for femoral aseptic loosening occurred in only 3 patients. Given the ability of this monoblock splined tapered stem to adequately provide fixation during complex revision THA, it remains a viable option in the setting of substantial femoral bone defects.
Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Hip Prosthesis/statistics & numerical data , Prosthesis Design/statistics & numerical data , Reoperation/instrumentation , Aged , Female , Femur/surgery , Hip Prosthesis/adverse effects , Humans , Joint Dislocations , Kaplan-Meier Estimate , Male , Middle Aged , Osseointegration , Postoperative Period , Retrospective Studies , TitaniumABSTRACT
Ankle fractures are common injuries frequently treated by foot and ankle surgeons. Therefore, it has become a core competency for orthopedic residency training. Surgical educators must balance the task of training residents with optimizing patient outcomes and minimizing morbidity and mortality. The present study aimed to determine the effect of resident involvement on the 30-day postoperative complication rates after open reduction and internal fixation of ankle fractures. A second objective of the present study was to determine the independent risk factors for complications after this procedure. We identified patients in the American College of Surgeons National Surgical Quality Improvement Program database who had undergone open reduction internal fixation for ankle fractures from 2005 to 2012. Propensity score matching was used to help account for a potential selection bias. We performed univariate and multivariate analyses to identify the independent risk factors associated with short-term postoperative complications. A total of 3251 open reduction internal fixation procedures for ankle fractures were identified, of which 959 (29.4%) had resident involvement. Univariate (2.82% versus 4.54%; p = .024) and multivariate (odds ratio 0.71; p = .75) analyses demonstrated that resident involvement did not increase short-term complication rates. The independent risk factors for complications after open reduction internal fixation of ankle fractures included insulin-dependent diabetes, increasing age, higher American Society of Anesthesiologists score, and longer operative times.
Subject(s)
Ankle Fractures/surgery , Fracture Fixation, Internal/adverse effects , Internship and Residency , Open Fracture Reduction/adverse effects , Postoperative Complications/etiology , Adult , Age Factors , Analysis of Variance , Diabetes Mellitus, Type 1 , Female , Humans , Logistic Models , Male , Middle Aged , Operative Time , Orthopedic Procedures/education , Propensity Score , Risk FactorsABSTRACT
PURPOSE: To investigate whether pelvic incidence (PI) in patients with symptomatic femoroacetabular impingement was different from that in a normal population. METHODS: Retrospective analysis of 30 consecutive female and 30 consecutive male patients with computed tomography scans who underwent hip arthroscopy for FAI. PI was measured using scout lateral radiographs. The center-edge angle (CEA), acetabular version, and α angle were also measured. Each patient was subcategorized as having a cam-type deformity (α angle >55°), a deep socket deformity (CEA >39°), and/or a retroverted acetabulum (acetabular anteversion <15°). Our group and subgroups were compared with a historical control group from a previously published study of 300 volunteers. Each group was compared using a Student t test. RESULTS: Our mean PI was 49.31° ± 12.34° (range, 28.4°-79.5°), less than the asymptomatic historical control (n = 300) with a mean PI of 55.0° ± 10.6° (range, 33°-82°) (P < .001). The subgroups for cam deformity, deep socket deformity, and acetabular retroversion have a mean PI of 48.89° ± 11.81°, 38.30° ± 7.56°, and 44.93° ± 11.32°, respectively. All had a significantly lower PI than the historical control (P < .001, P < .001, P < .001, respectively). CONCLUSIONS: We conclude that patients presenting with FAI may have a lower PI than the general population. The clinical significance of a 5.7° difference in PI remains unknown. LEVEL OF EVIDENCE: Level III, retrospective comparative study.
Subject(s)
Femoracetabular Impingement/diagnostic imaging , Hip Joint/diagnostic imaging , Pelvic Bones/diagnostic imaging , Postural Balance/physiology , Adolescent , Adult , Aged , Female , Femoracetabular Impingement/physiopathology , Hip Joint/physiology , Historically Controlled Study , Humans , Male , Middle Aged , Pelvic Bones/physiology , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Increased surgeon volume may be associated with improved outcomes following operative procedures. However, there is a lack of information on the effect of surgeon volume on inpatient adverse events and resource utilization following total ankle arthroplasty (TAA). METHODS: A retrospective cohort study of TAA patients was performed using the Nationwide Inpatient Sample (NIS) from 2003 to 2009. High-volume surgeons were considered as those with volume ≥90th percentile of surgeons performing TAA. Multivariate regression was used to compare the rates of adverse events, hospital length of stay, and total hospital charges between surgeon volume categories. RESULTS: A total of 4800 TAA patients were identified. The 90th percentile for surgeon volume was 21 cases per year. Mean length of stay was 2.8 ± 2.3 days and mean hospital charges were $45 963 ± $43 983. On multivariate analysis, high-volume surgeons had decreased overall complications (OR 0.5, P = .034) and rate of medial malleolus fracture (OR 0.1, P = .043), decreased length of stay (-0.9 days, P < .001), and decreased hospital charges (-$20 904, P < .001). CONCLUSIONS: Surgeons with volume ≥90th percentile had a decreased rate of complications, decreased length of stay, and reduced hospital charges compared to other surgeons. LEVEL OF EVIDENCE: Level III, comparative study.
Subject(s)
Arthroplasty, Replacement, Ankle , Health Care Costs , Length of Stay , Orthopedic Surgeons , Postoperative Complications , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Ankle/adverse effects , Arthroplasty, Replacement, Ankle/economics , Clinical Competence , Female , Hospitalization , Humans , Male , Middle Aged , Regression Analysis , Retrospective Studies , Young AdultABSTRACT
In this retrospective cohort study of 280 primary total knee arthroplasties, clinical outcomes relevant to hemostasis were compared by electrocautery type: traditional electrocautery (TE), bipolar sealer (BS), and argon beam coagulation (ABC). Age, sex, and preoperative diagnosis were not significantly different among the TE, BS, and ABC cohorts. The 3 hemostasis systems were statistically equivalent with respect to estimated blood loss. Wound drainage during the first 48 hours after surgery was equivalent between the BS and ABC cohorts but less for the TE cohort. Transfusion requirements were not significantly different among the cohorts. The 3 hemostasis systems were statistically equivalent with respect to mean change in hemoglobin level during the early postoperative period (levels were measured on postoperative day 1 and on discharge). As BS and ABC are clinically equivalent to TE, their increased cost may not be justified.
Subject(s)
Argon Plasma Coagulation , Arthroplasty, Replacement, Knee/methods , Blood Loss, Surgical/prevention & control , Electrocoagulation , Hemostasis, Surgical/methods , Humans , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: Hip arthroscopy utilization is on the rise in the United States. Thus, determining the impact of prior hip arthroscopy on subsequent total hip arthroplasty (THA) is important to understand. METHODS: A retrospective review of a high-volume orthopedic surgery practice's billing database yielded 42 hip arthroscopies that underwent subsequent THA. An age-, sex-, and body mass index (2:1)-matched cohort of primary THAs was used for comparison. RESULTS: No difference was observed in the postoperative Harris Hip Score between groups (92.1 ± 10.9 vs 90.1 ± 6.6, P = .20); however, there was greater overall improvement in Harris Hip Score in the control group (40.4 ± 18.4 vs 45.1 ± 8.7, P = .05). There were no differences observed in the complication (P = .5) or revision rates (P = .4). CONCLUSION: With the numbers available, prior hip arthroscopy does not appear to have an impact on the functional outcomes of a subsequent THA.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroscopy/adverse effects , Hip Joint/surgery , Joint Diseases/surgery , Reoperation/adverse effects , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
Pigmented villonodular synovitis is a rare proliferative condition of the synovium that affects large joints. The primary treatment options are synovectomy and a combination of synovectomy and arthroplasty. We performed a systematic review of the literature, excluding all nonclinical and review articles with follow-up of less than 2 years. Primary outcomes reported were disease recurrence, symptom progression, and revision surgery. Student t tests were used to compare outcomes after synovectomy with outcomes after synovectomy combined with arthroplasty. Twenty-one studies (82 patients) were included. All represented level IV or V evidence. Fifty-one patients (59.3%) were female. Mean (SD) age was 33.2 (12.6) years. Synovectomy alone was performed in 45 patients (54.9%), and synovectomy with arthroplasty was performed in 37 patients (45.1%). Mean (SD) follow-up was 8.4 (5.9) years. The groups' revision rates were not significantly different (26.2% vs 24.3%; P = .17). Mean (SD) time to revision was significantly (P = .02) longer in the synovectomy-with-arthroplasty group, 11.8 (4.5) years, than in the synovectomy-only group, 6.5 (3.9) years. Study results showed revisions are common after surgery for hip pigmented villonodular synovitis, affecting 1 in 4 patients regardless of which surgery they have-either synovectomy alone or synovectomy combined with arthroplasty. Revision is required sooner in synovectomy-only patients than in patients who also undergo arthroplasty.
Subject(s)
Hip Joint , Synovitis, Pigmented Villonodular/surgery , Arthroplasty , Humans , SynovectomyABSTRACT
BACKGROUND: Non-Hodgkin's lymphoma (NHL) of bone is a rare musculoskeletal malignancy accounting for fewer than 7% of bone cancers. Traditionally, we have treated patients who have NHL of bone with chemotherapy and radiation therapy, but the role of radiotherapy in disease management and patient functional outcomes after treatment have not been well studied. We investigated the survival advantage of radiotherapy in a large cohort of patients with NHL of bone and assessed associated patient complications of radiotherapy. QUESTIONS/PURPOSES: The objective of this study was to compare patients treated for NHL of bone with and without radiation in terms of (1) overall survival; (2) pretreatment complications; (3) posttreatment complications; and (4) functional outcomes using the Musculoskeletal Tumor Society (MSTS) score. METHODS: A retrospective analysis of all patients with biopsy-proven NHL of bone diagnosed at our institution between 1985 and 2013 was undertaken; 70 patients met our criteria for inclusion with minimum followup of 6 months (median, 55 months; range, 10-219 months). Overall survival at 5 and 10 years was estimated and compared between two groups of patients: one group treated with systemic therapy alone (chemotherapy, rituximab; 46 patients [66%]) and the other with combined modality therapy (systemic therapy and radiotherapy; 24 patients [34%]). During the period in question, indications for radiotherapy included bulky disease, an abbreviated course of systemic therapy, and an incomplete response to systemic therapy. Patients not meeting these criteria generally received systemic therapy alone. With the available sample size, it was estimated that a difference in survival of approximately 30% would have to be present for detection with 80% power (α = 0.05, ß = 0.2, n = 70, Δ = 30%). Pretreatment and posttreatment complications occurring in both patient groups were retrospectively reviewed with special emphasis on fracture healing after treatment. MSTS scores were obtained for 45 patients with appendicular tumors at a median followup of 42 months (range, 10-215 months). RESULTS: With the data available, no difference in Kaplan-Meier survivorship was observed between patients treated with and without radiation at 5 years (98%; 95% confidence interval [CI], 93%-100% versus 95%; 95% CI, 85%-100%; p = 0.281). Patients who were treated with radiation were more likely to experience problems with fracture healing (relative risk [RR], 12.8; 95% CI, 1.8-89.8; p = 0.01). Similarly, patients treated with radiation were at a higher risk for fracture in the posttreatment period (five of 24 versus no radiation zero of 46; RR, 20.7; 95% CI, 1.2-359.0; p = 0.0375). MSTS scores were poorer in patients treated with radiation (75% versus 91%; p = 0.034) attributable in part to a higher incidence of bony complications in this group after treatment. CONCLUSIONS: Based on the numbers of patients in our study, we could not demonstrate a survival advantage with radiation use. Rather, radiotherapy may be associated with orthopaedic complications occurring during and after treatment. Larger, prospective studies are necessary to definitively establish whether radiation is necessary for the treatment of patients with lymphoma of bone. LEVEL OF EVIDENCE: Level III, therapeutic study.
Subject(s)
Bone Neoplasms/radiotherapy , Lymphoma, Non-Hodgkin/radiotherapy , Radiotherapy/methods , Biopsy , Bone Neoplasms/drug therapy , Combined Modality Therapy , Disease Management , Female , Humans , Lymphoma, Non-Hodgkin/drug therapy , Male , Middle Aged , Radiotherapy/adverse effects , Retrospective Studies , Risk Factors , Survival Rate , Treatment OutcomeABSTRACT
This study compares the rate of dislocation and revision for instability between 36-mm and anatomic femoral heads (large diameter metal-on-metal THA, dual-mobility bearings, and hip resurfacing arthroplasty) in patients at high risk for dislocation. A total of 501 high-risk patients, over a 10-year period, were identified (282 36-mm THA, 24 dual-mobility bearings, 83 metal-on-metal arthroplasty, and 112 hip resurfacing arthroplasty). There were 13 dislocations in the 36-mm group compared to 1 in the anatomic group (4.6% vs 0.5%; P = .005). Four patients dislocated more than once in the 36-mm group (1.4% vs 0%; P = .04), and 2 patients in the 36-mm group required a revision for instability (0.7% vs 0%; P = .11). These results suggest that anatomic head sizes significantly lower the risk of dislocation in high-risk patients.
Subject(s)
Arthroplasty, Replacement, Hip/instrumentation , Femur Head/surgery , Hip Dislocation/etiology , Hip Prosthesis/adverse effects , Adult , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/methods , Female , Hip Dislocation/prevention & control , Humans , Male , Metals , Polyethylene/chemistry , Prosthesis Failure , Reoperation , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: Unicompartmental knee arthroplasty (UKA) is an increasingly popular procedure, with excellent long-term outcomes. However, there are only a limited number of reports reporting its short-term morbidity and mortality. QUESTIONS/PURPOSES: We sought to analyze the reported 30-day morbidity, mortality, and risk factors for complications and prolonged length of stay (>4 days) following UKA. PATIENTS AND METHODS: Utilizing the National Surgical Quality Improvement Program (NSQIP) database, including patients (n = 2316) from 2005-2012, we correlated the reported 30-day complications and prolonged length of stay with patient demographics and risk factors. RESULTS: The overall rate of complications was low (3.2%). The distribution of complications demonstrated 0.5% major systemic, 1.4% minor systemic, 0.7% major local, and 0.9% minor local complications, with a 2.1% readmission rate. Multivariate regression demonstrated increased BMI and a history of chronic obstructive pulmonary disease (COPD) as independent risk factors for complications. Furthermore, multivariate regression demonstrated increased BMI, ASA ≥ 3, history of COPD, recent operation, and postoperative transfusion as independent risk factors for prolonged length of hospitalization. CONCLUSIONS: Utilizing the NSQIP, we present one of the largest studies to date evaluating complications following UKA. Our multivariate model demonstrated obesity and COPD to be the risk factors for complications while obesity, ASA ≥ 3, COPD, recent operation, and blood transfusion to be the risk factors for prolonged length of stay.
ABSTRACT
Deep fungal infection localized to the foot is not common, and when it occurs it often affects immunocompromised individuals. In this report, we describe the case of an adult diabetic patient who suffered with with Blastomycosis infection of the flexor digitorum longus and peroneal tendon sheaths. The condition was treated with systemic antifungal therapy and surgical debridement.
Subject(s)
Ankle Joint , Antifungal Agents/therapeutic use , Blastomyces , Blastomycosis/surgery , Bone Diseases, Infectious/surgery , Tenosynovitis/surgery , Abscess/diagnosis , Abscess/drug therapy , Abscess/surgery , Ankle , Ankle Joint/microbiology , Ankle Joint/surgery , Blastomycosis/complications , Blastomycosis/diagnosis , Blastomycosis/drug therapy , Bone Diseases, Infectious/complications , Bone Diseases, Infectious/diagnosis , Bone Diseases, Infectious/drug therapy , Debridement , Diabetes Mellitus, Type 1/complications , Foot , Humans , Tenosynovitis/complications , Tenosynovitis/diagnosis , Tenosynovitis/drug therapy , Therapeutic IrrigationABSTRACT
Perioperative transfusions increase complications and cost following THA. Current series evaluating neuraxial anesthesia and blood loss following THA are small and utilize heterogeneous populations. Using the NSQIP database we compared transfusion rates following THA with neuraxial and general anesthesia. Between 2005 and 2012, 28,857 THAs (11,317 neuraxial anesthesia) were identified. Univariate analysis showed lower rates of transfusion, pneumonia, unplanned intubation, prolonged intubation, stroke, all complications, and medical complications in the neuraxial group. Operative time and length of stay were shorter with neuraxial anesthesia as well. After adjusting for patient comorbidities, a multivariate regression model showed fewer transfusions with neuraxial anesthesia. The multivariate regression model showed additional independent risk factors for transfusion including gender, operative time, elevated INR, and a history of hypertension, metastatic cancer, and renal failure.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, General/methods , Anesthesia, Spinal/methods , Arthroplasty, Replacement, Hip/methods , Arthroplasty, Replacement, Knee/methods , Blood Transfusion/statistics & numerical data , Aged , Anesthesia, Epidural/adverse effects , Anesthesia, General/adverse effects , Anesthesia, Spinal/adverse effects , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Comorbidity , Databases, Factual , Female , Humans , Hypertension/complications , International Normalized Ratio , Kidney Diseases/complications , Male , Middle Aged , Multivariate Analysis , Neoplasms/complications , Operative Time , Pneumonia , Prospective Studies , Risk Factors , Treatment Outcome , United StatesABSTRACT
BACKGROUND: The impact of resident involvement on total shoulder arthroplasty (TSA) complication rate is unknown. The purpose of this study was to assess whether resident involvement in TSA is associated with 30-day complication rates. METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was searched for all patients who underwent TSA between 2005 and 2012. Data were extracted for patient preoperative demographics, intraoperative variables, resident involvement in surgery, and 30-day postoperative complications. Resident and nonresident cases were grouped by a matched propensity score analysis. Univariate and multivariate analysis was performed to assess the effect of resident involvement on postoperative complications. RESULTS: We analyzed 1382 patients who underwent primary TSA, with matched groups of 691 with and 691 without resident involvement. The overall rate of 30-day complications was 2.60% in TSAs in which a resident was involved compared with 3.91% when no resident was involved (P = .173). Operative time and hospital stay were shorter in cases in which a resident was present (P = .002 and P < .001, respectively). Independent risk factors significantly associated with TSA complications identified by multivariate regression were higher patient age, higher American Society of Anesthesiologists classification, congestive heart failure, insulin-dependent diabetes, and peripheral vascular disease. CONCLUSION: Resident involvement in TSA procedures is not a risk factor for 30-day complications. Patient factors including increased age, diabetes, and cardiac disease are risk factors for TSA complications. This information can be used in preoperative counseling to reassure patients about safety of resident involvement in TSA and to optimize patient comorbidities before surgery.
Subject(s)
Arthroplasty, Replacement/adverse effects , Internship and Residency , Shoulder Joint/surgery , Age Factors , Aged , Arthroplasty, Replacement/statistics & numerical data , Case-Control Studies , Databases, Factual , Female , Humans , Length of Stay , Male , Operative Time , Propensity Score , Retrospective Studies , Risk FactorsABSTRACT
Disruption of the extensor mechanism as a result of patellar tendon or quadriceps tendon rupture is an uncommon but devastating complication after total knee arthroplasty. Treating a disrupted extensor mechanism can be challenging, particularly in patients who are morbidly obese, due to an increased risk of postoperative complications. Therefore, despite the debilitating nature of extensor mechanism disruption, many community surgeons do not feel comfortable pursuing more complex cases like revision total knee arthroplasty with extensor mechanism allograft on morbidly obese patients, and consequently many of these patients are referred to tertiary-care centers for reconstruction secondary to the complexity of this patient cohort. The authors report 2 cases of bilateral extensor mechanism disruption after total knee arthroplasty in patients who are morbidly obese. One patient experienced trauma leading to her initial rupture; however, her contralateral atraumatic disruption was subsequently diagnosed at a later date. The second patient did not experience trauma leading to either of her extensor mechanism disruptions. Despite substantial medical comorbidities and morbid obesity, revision total knee arthroplasties with extensor mechanism allografts were recommended in both cases in a staged bilateral fashion. The surgical technique is described and the unique challenges afforded by the marked obesity are detailed. The current literature on this subject is reviewed. Despite early complications related to recumbency, this report serves as an example of successful repairs of extensor mechanism disruptions in patients who are morbidly obese, suggesting that extensor mechanism allograft is viable even in patients with high risk of complications.
Subject(s)
Arthralgia/surgery , Arthroplasty, Replacement, Knee/methods , Knee Joint/surgery , Obesity, Morbid/complications , Patellar Ligament/injuries , Postoperative Complications/etiology , Aged , Allografts , Female , Humans , Knee Joint/diagnostic imaging , Middle Aged , Patellar Ligament/surgery , Postoperative Complications/surgery , Radiography , Plastic Surgery Procedures/methods , Reoperation , Rupture/etiology , Rupture/surgery , Rupture, Spontaneous/etiology , Rupture, Spontaneous/surgery , Treatment OutcomeABSTRACT
PURPOSE: To identify the accuracy of measuring the alpha angle on the false-profile, anteroposterior (AP), and 90° Dunn lateral views of the hip as compared with computed tomography (CT) scan findings. METHODS: Forty patients were needed to have power greater than 80%. Forty-five consecutive patients undergoing hip arthroscopy were retrospectively reviewed with preoperative radial oblique CT reformatted scans and plain radiographs. Alpha angles were measured on plain radiographs (AP, 90° Dunn lateral, and false profile) and CT reformatted views. Abnormal alpha angles were considered greater than 50.5°. Two orthopaedic surgeons independently measured the images, and the results were compared between imaging modalities. RESULTS: The false-profile view was 60% sensitive and 89.0% specific for diagnosing cam deformities of the hip. All radiographs combined were 86% sensitive and 75% specific for diagnosing cam deformities. The false-profile view most strongly correlated with the 2-o'clock (R = 0.746, P = .001) and 3-o'clock (R = 0.698, P < .0001) positions. An intraclass correlation coefficient of 0.81 was found for measurement of the alpha angle on the false-profile view. CONCLUSIONS: This study has proved that the false-profile view effectively characterizes cam deformity, especially anterior deformity at the 3-o'clock position. Measuring the alpha angle on the false-profile view appears to be reproducible. The false-profile view along with standing AP pelvis and 90° Dunn lateral views of the hip comprises a good screening radiographic series for patients presenting with symptoms of femoroacetabular impingement. LEVEL OF EVIDENCE: Level III, diagnostic study.
Subject(s)
Femoracetabular Impingement/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Arthroscopy , False Positive Reactions , Female , Femoracetabular Impingement/surgery , Femur Head/diagnostic imaging , Humans , Male , Middle Aged , Predictive Value of Tests , Retrospective Studies , Young AdultABSTRACT
BACKGROUND: Although metal-on-metal (MoM) bearing surfaces provide low rates of volumetric wear and increased stability, evidence suggests that certain MoM hip arthroplasties have high rates of complication and failure. Some evidence indicates that women have higher rates of failure compared with men; however, the orthopaedic literature as a whole has poorly reported such complications stratified by gender. QUESTIONS/PURPOSES: This systematic review aimed to: (1) compare the rate of adverse local tissue reaction (ALTR); (2) dislocation; (3) aseptic loosening; and (4) revision between men and women undergoing primary MoM hip resurfacing arthroplasty (HRA). METHODS: Systematic MEDLINE and EMBASE searches identified all level I to III articles published in peer-reviewed journals, reporting on the outcomes of interest, for MoM HRA. Articles were limited to those with 2-year followup that reported outcomes by gender. Ten articles met inclusion criteria. Study quality was evaluated using the Modified Coleman Methodology Score; the overall quality was poor. Heterogeneity and bias were analyzed using a Mantel-Haenszel statistical method. RESULTS: Women demonstrated an increased odds of developing ALTR (odds ratio [OR], 5.70 [2.71-11.98]; p<0.001), dislocation (OR, 3.04 [1.2-7.5], p=0.02), aseptic loosening (OR, 3.18 [2.21-4.58], p<0.001), and revision (OR, 2.50 [2.25-2.78], p<0.001) after primary MoM HRA. CONCLUSIONS: A systematic review of the currently available literature reveals a higher rate of complications (ALTR, dislocation, aseptic loosening, and revision) after MoM HRA in women compared with men. Although femoral head size has been frequently implicated as a prime factor in the higher rate of complication in women, further research is necessary to specifically probe this relationship. Retrospective studies of data available (eg, registry data) should be undertaken, and moving forward studies should report outcomes by gender (particularly complications). LEVEL OF EVIDENCE: Level III, therapeutic study.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/instrumentation , Hip Joint/surgery , Hip Prosthesis , Metal-on-Metal Joint Prostheses , Postoperative Complications/etiology , Chi-Square Distribution , Female , Foreign-Body Reaction/etiology , Hip Joint/physiopathology , Humans , Male , Odds Ratio , Postoperative Complications/diagnosis , Postoperative Complications/surgery , Prosthesis Design , Prosthesis Failure , Reoperation , Risk Assessment , Risk Factors , Sex Factors , Treatment OutcomeABSTRACT
CASE: Primary lymphoma of bone is a rare musculoskeletal malignancy that typically arises in long bones. Few cases of bone lymphoma occurring alongside orthopaedic implants have been reported in the literature. We describe the complex case of a seventy-eight-year-old woman who developed diffuse large B-cell lymphoma of the proximal part of the tibia five years after a successful total knee arthroplasty. CONCLUSION: Several studies have suggested a link between orthopaedic implants and genomic instability, although true carcinogenesis remains questionable. Lymphoma complicating joint arthroplasty poses a unique problem for orthopaedic physicians due to diagnostic challenges and the unique implications of disease and treatment-related complications.