Total Hip Lithiasis: A Rare Sequelae of Spilled Gallstones.

Laparoscopic cholecystectomy is a surgical treatment for acute cholecystitis or symptomatic cholelithiasis. One potential complication, the spillage of gallstones into the peritoneal cavity, can form a nidus for infection and may be associated with hepatic, retroperitoneal, thoracic, and abdominal wall abscesses. We report a case of a patient presenting with a right iliopsoas abscess and an infected right hip prosthesis status postlaparoscopic cholecystectomy. A CT demonstrated that the acetabular shell was overmedialized and perforated through the medial wall. The patient was taken to the operating room for explantation of components. A collection of gallstones was identified deep to the acetabulum during the explantation. The case highlights the importance of avoiding overmedialization of the acetabular component, which can provide a direct route for infection into the hip joint.

Partial Denervation and Anterior Release of the Hip Joint Capsule to Relieve Pain and Improve Function at Five Years Follow-up.

Traditionally, patients with significant hip pain due to degenerative hip disease, who are not surgical candidates for a total hip arthroplasty (THA), or are wary of the procedure, have been managed with various modalities with variable effectiveness. OBJECTIVES: We have recently developed an anterior release of the contracted hip capsule along with par- tial denervation ofthe hip joint performed on an out- patient basis to relieve pain and improve function. STUDY DESIGN: A case series of 24 patients. METHODS: From November 2007 to April 2009, 24 partial,denervation procedures through an anterior approach were performed by a single surgeon. A clinical survey was conducted five years following the intervention. RESULTS: Eighteen ofthe 24 patients were alive at the time of follow-up. Four of the six patients who were deceased at the time of follow-up had not undergone aTHA while two had. Fifteen ofthe 18 patients who were still living received a THA while three did not. Ihe interval time to arthroplasty was 19 months.

Ceramic-on-Ceramic Total Hip Arthroplasty in a Twelve-Year-Old Patient: Case Report with a 27-Year Follow-Up.

Total hip arthroplasty in the juvenile patient with a severely diseasedjoint can provide long-term pain relief and improvement in function. We present a patient with juvenile rheumatoid arthritis who underwent a Mittelmeier ceramic-on-ceramic total hip arthroplasty at age 12 in 1986. The implant provided the patient with a functioning hip for 24 years, but subsequently required revision due to femoral component loosening. This case report represents the longest reported clinical follow-up of noncemented, ceramic-on-ceramic total hip arthroplasty in a juvenile patient and depicts an excellent outcome at 27 years. Our case is also unique in that the Mittelmeier ceramic acetabulum was left in place during revision surgery. In this report, we also describe the senior author's choice of the Mittelmeier hip prosthesis within its historical context and provide a brief review of the literature as it relates to total hip arthroplasty in the juvenile patient.

Bladder tear during revision total hip arthroplasty.

Total hip arthroplasty (THA) and revision total hip arthroplasty are among the most commonly performed orthopedic procedures. There are many reported complications of THA, but intrapelvic complications are a rare subset. Bladder injuries have infrequently been described in association with this common procedure. We present an unusual case of a bladder tear occurring intraoperatively during a revision THA. It is suspected that the patient's history of multiple prior hip procedures caused adhesions of the bladder to the pelvic floor and predisposed the bladder to injury during acetabular revision. Previous reports of bladder injury relating to THA have described thermal necrosis, component migration, and occasional direct perforation. There are no prior case reports describing bladder tears related to adhesions occurring intraoperatively during revision THA. This case report highlights the importance of surgeon awareness of an unusual complication. In this case, intraoperative and postoperative recognition of a hematuria diagnosis led to the appropriate treatment, and this patient had an acceptable outcome.

Total hip arthroplasty followed by traction and delayed reduction for Crowe IV developmental dysplasia of the hip.

Hip dislocation secondary to developmental dysplasia of the hip is a debilitating condition. Total hip arthroplasty has proven successful in improving pain, restoring joint function, and correcting leg length discrepancies in this select population. Various techniques have been developed to address the increased complexity inherent to the reconstruction of the severely dysplastic hip. Despite this, femoral and/or sciatic nerve palsy remains a potential catastrophic complication after surgery, with reported rates up to five times that in the general population. We present three cases using a previously unreported technique for performing primary total hip arthroplasty via an anterior approach for Crowe IV hip dysplasia. The goal of this technique is to minimize the risk of postoperative nerve palsy following reconstruction of the severely dysplastic hip. A brief discussion of our technique and the topic of nerve dysfunction after total hip arthroplasty for developmental dysplasia of the hip follows.

Recovery room radiographs after total hip arthroplasty: tradition vs utility?

Routine inpatient radiographs after total hip arthroplasty can be taken in the recovery room immediately after surgery or in the radiology suite later in the hospital stay. In a review of 632 consecutive recovery room series, we found that 17% of series were inadequate to detect technical issues. We identified technical issues on 12 series (1.9%) and technical issues that impacted inpatient management on 2 series (0.3%). One of these 2 was a dislocation that was detected clinically before imaging. The other was a medial penetration of an acetabular screw that probably did not require the immediate revision that it received. Findings suggest that the single routine inpatient series should be taken in the radiology suite, rather than in the recovery room.

Revision total hip arthroplasty using the Zweymuller femoral stem.

BACKGROUND: A variety of femoral stem designs have been reported to be successful in revision total hip arthroplasty without consensus as to optimal design. We evaluated the clinical and radiographic outcomes in a consecutive series of femoral revisions using a wedge-shape, tapered-stem design at medium and long-term follow-up. MATERIALS AND METHODS: We performed a retrospective review of clinical and radiographic outcomes of twenty-eight consecutive femoral revisions arthroplasties, which were done using the Zweymuller femoral stem. RESULTS: The mean follow-up was 7.4 years (range 2-15 years). No stem re-revision was necessary. All stems were judged to be stable by radiographic criteria at the most recent follow-up. The final mean Harris hip score was 90. There was no difference in Harris hip scores, implant stability, or radiological appearance (distal cortical hypertrophy or proximal stress shielding) of the implants between medium-term (mean 5.7 years) and long-term (mean 12.4 years) follow-up. CONCLUSIONS: We found the Zweymuller femoral stem design to be durable for revision hip arthroplasty when there is an intact metaphyseal-diaphyseal junction for adequate press-fit stability at surgery.

Revision total hip arthroplasty in a centenarian: a case report and review of the literature.

The clinical success of primary total hip arthroplasty in elderly patients is well established. Because of the rapid growth rate of the population aged 85 years and older and the increasing life expectancy of this group of patients, the number of patients in their 8th, 9th, and even 10th decades of life requiring revision total hip arthroplasty will increase. We present the only documented case of revision total hip arthroplasty in a centenarian and a review of the relevant literature.

Incidence of heterotopic ossification following total hip arthroplasty in patients with prior stroke.

This study reviewed the incidence of heterotopic ossification and the functional limitations in a cohort of consecutive patients with prior stroke who underwent primary total hip arthroplasty (THA). Thirty-one primary THAs were performed in 22 patients who had a cerebrovascular accident prior to THA. Mean follow-up 35 months. The overall incidence of heterotopic ossification was 36%, with significant Brooker class III and IV heterotopic ossification reported in 22% of patients. The data suggest that prior cerebrovascular accident may pose an increased risk of significant heterotopic ossification following primary THA. Consideration of prophylaxis in this subset of patients may be warranted.

One-stage bilateral total hip arthroplasty in patients > or = 75 years.

Since 1991, 43 one-stage sequential bilateral total hip arthroplasties (THAs) inpatients > or = 75 years have been performed by the authors. The results were assessed to determine whether thiss procedure can be performed safely and with good outcome in this subset of patients. These results were compared to those of 1 36 patients < 75 years who underwent the same procedure. The one-stage bilateral procedure was performed in all patients who had signiificant arthritic disease of both hips. There was no diffference in length of surgery or length of hospital stay. Patients > or = 75 years were more likely to experience minor postoperative morbidity such as ileus and urinary tract infections. The incidence of myocardial ischemia was 2.3% in the elderly group With a mean follow-up of 2.5 years, 90% of the elderly patients lived independently, 80% walked without assistive devices, and 90% were pain free. Therefore, one-stage sequential bilateral THA is a safe and effective option for patients > or = 75 years when pain and functional limitations affect quality of life.