Patients report improvement in quality of life and satisfaction after hip resurfacing arthroplasty.

BACKGROUND: A number of reconstructive procedures are available for the management of hip osteoarthritis. Hip resurfacing arthroplasty is now an accepted procedure, with implant survivorship comparable to THA at up to 10 years' followup in certain series. Most reports focus on implant survivorship, surgeon-derived results, or complications. Fewer data pertain to patient-reported results, including validated measures of quality of life (QoL) and satisfaction and baseline measures from which to determine magnitude of improvement. Validated patient-reported results are essential to guide patients and surgeons in the current era of informed and shared decision making. QUESTIONS/PURPOSES: We determined whether patients reported improvement in disease-specific, joint-specific, and generic QoL after hip resurfacing arthroplasty; whether patients were satisfied with the results of the procedure; and latest activity level and return to sport. METHODS: We retrospectively reviewed 127 patients (100 men, 27 women) who underwent 143 hip resurfacing procedures between 2002 and 2006. Mean patient age was 52 years. Patients completed the WOMAC, Oxford Hip Score, and SF-12 at baseline and again at minimum 2-year followup (mean, 2.5 years; range, 2-6 years). At latest followup, patients completed a validated satisfaction questionnaire and UCLA activity score. RESULTS: All QoL scores improved (normalized to a 0-100 scale, where 100 = best health state). WOMAC improved from 46 to 95, Oxford Hip Score from 42 to 95, SF-12 (physical) from 34 to 54, and SF-12 (mental) from 46 to 56. Patient satisfaction score was 96. UCLA activity score was 8. CONCLUSIONS: The majority of patients reported improvement in QoL, were very satisfied with their outcome, and returned to a high level of activity after hip resurfacing arthroplasty. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Septic arthritis following anterior cruciate ligament reconstruction secondary to Clostridium sporogenes; a rare clinical pathogen.

A case of septic arthritis post anterior cruciate ligament reconstruction secondary to Clostridium sporogenes is described in a 19-year-old man. C sporogenes is a rare clinical pathogen and this is believed to be the first case of septic arthritis due to the organism. The patient responded to arthroscopic washout, synovectomy and combination antibiotic therapy. A review of the literature is also presented.

Modular tantalum augments for acetabular defects in revision hip arthroplasty.

UNLABELLED: Large acetabular defects can be reconstructed with various methods depending on size and location of the defect. We prospectively followed our first 37 patients in whom we reconstructed the acetabulum with a trabecular metal augment combined with a trabecular metal shell. Three patients died before completing the minimum 24 months followup while the remaining 34 were followed a minimum of 24 months (mean, 34 months; range, 24-55 months). All defects were classified according to Paprosky. Radiographic signs of osseointegration were classified according to Moore. Quality of life was measured with the SF-12, WOMAC, and Oxford Hip Score. There were 15 men and 19 women with an average age of 64 years. At a minimum of two years followup 32 of the 34 patients required no further surgery for aseptic loosening, while two had rerevision. Of the 32 patients who had not been revised, all had stable cups radiographically. All quality-of-life parameters improved. The early results with tantalum augments are promising but longer followup is required. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Salvage procedures and implant selection for periprosthetic femoral fractures.

Periprosthetic femoral fractures with severe bone loss are challenging to treat. There are various treatment options, depending on the severity of the bone loss, age and activity of the patient and experience of the surgeon. This review focuses on the treatment of these Vancouver type B3 fractures with long-stem implants, proximal femoral replacements, allograft-prosthesis composites and cortical strut grafting.

Standard open decompression in carpal tunnel syndrome compared with a modified open technique preserving the superficial skin nerves: a prospective randomized study.

PURPOSE: A common surgical treatment for carpal tunnel syndrome is open carpal tunnel decompression. This involves skin incision followed by sharp dissection straight down through fat and palmar fascia to the transverse carpal ligament, which is then divided. The incidence of scar discomfort ranges from 19% to 61%, and its cause is not fully understood. We conducted a prospective randomized controlled trial to investigate whether preservation of superficial nerve branches crossing the incision site reduces the incidence and severity of postoperative scar pain after open carpal tunnel release. METHODS: Forty-two patients with bilateral idiopathic carpal tunnel syndrome (84 hands) were included in the study. The patients were randomized to determine which hand was to have carpal tunnel decompression using a technique that would try to preserve the superficial nerve branches. The other hand had open carpal tunnel decompression without any attempt to preserve the superficial nerve branches. An assessment of each hand in each patient was performed immediately before surgery and at 6 weeks, 3 months, and 6 months after surgery. This assessment was performed with a questionnaire based on the Patient Evaluation Measure. RESULTS: We found no evidence of a difference in scar pain between the 2 methods at 6 weeks, 3 months, and 6 months. There was a significant difference in the length of surgery between the 2 groups. CONCLUSIONS: Scar pain scores in this series of open carpal tunnel decompressions were similar, whether or not an attempt was made to identify and preserve superficial nerve branches crossing the wound.