Long-term effectiveness of Sorbie-QUESTOR elbow arthroplasty: single surgeon's series of 15 years.

With increasing usage of many types of total elbow replacements, there is a continuing need for clinical series that report survivorship, complications and revisions, and performance of single types of implants over extended time periods. The purpose of this study was to assess the long-term effectiveness of all implants of the Sorbie-QUESTOR (SQ) unlinked surface arthroplasty conducted by a single surgeon (C.S.) over 15 years at a single site, and to determine whether there were diagnostic group differences. Between 1995 and 2002, 51 S-Q prosthetic elbows were implanted into 44 patients. The patient groups were hemophilia, rheumatoid arthritis, and "other," which included osteoarthritis, traumatic arthritis, psoriatic arthritis, and reactive arthritis. Annual evaluations included scores of pain, range of motion, and function. The most recent annual evaluation was included in the data set. Details of complications and revisions were recorded. The hemophiliac group had the best survival outcomes at 87.5%. Eighteen prostheses required revision or removal with all but 3 retained or replaced. Postoperatively, 73% rated their pain as 'slight' or 'none'. The hemophilia and rheumatoid arthritis groups made very large total flexion/extension gains. The rheumatoid arthritis group made significant forearm motion gains. Average functional assessment gains were nearly 2 grades of 5 functional levels and were significant for all groups. The S-Q surface arthroplasty has demonstrated long-term effectiveness in patients with a variety of elbow joint pathologies showing reduction in pain, large gains in joint range and function, and good long-term survival.

Hemiarthroplasty in the treatment of hallux rigidus.

BACKGROUND: Osteoarthritis of the first metatarsophalangeal (MTP) joint is a painful, disabling condition. It can interfere with the ability to run and even walk without pain. An implant of cobalt-chrome steel alloy to replace the base of the proximal phalanx is one solution. The purpose of this study is to review our results with one of these implants. MATERIALS AND METHODS: A series of 23 cases of hemiarthroplasty for the treatment of hallux rigidus from June 2000 to October 2001 has been evaluated using the AOFAS rating system, and the results are presented. RESULTS: The average preoperative AOFAS score was 57 (range, 39 to 80). The AOFAS score after hemiarthroplasty was 88 (range, 75 to 100) at last followup (34 to 72 months). There were no perioperative complications except for a small hematoma. Only one patient has required further surgery after 3 years for worsening of a preexisting tendency to hallux valgus. CONCLUSION: A hemiarthroplasty retained, in most cases, joint mobility, strength, and alignment while relieving pain. There was no evidence, at last followup, of component loosening or osteolysis.

Arthroplasty in the treatment of subcapital hip fracture.

After reviewing recent literature on the treatment of displaced intracapsular fractures of the femoral neck (Garden types III and IV) and from personal experience, a number of conclusions can be made. Orthopedic surgeons and hospitals face the challenge of providing the treatment most beneficial to patients with intracapsular, subcapital hip fractures in the most cost-effective way. The numbers of patients will increase annually and exceed the 125,000 per year at present in the United States. Most authors agree that fractures with the least displacement and younger, more demanding patients will do well with a precise fracture reduction without delay and an accurately placed internal fixation system. However, an overall median risk for reoperation 2 years after internal fixation is 35%. A patient with a displaced intracapsular fracture will need to consider monopolar, bipolar, or THA as the treatment of choice. Monopolar and bipolar arthroplasty have a reduced survivorship compared to THA and are not as suitable for the younger, more active patient. A large femoral head implant leads to decreased motion from increased friction and an undersized head implant leads to reduced contact area with increased erosion and pain. Bipolar arthroplasties, while allowing early mobilization, may develop some of the characteristics of monopolar implants if motion is not mainly at the internal joint. The increased cost may not justify their use over monopolar arthroplasty. Should dislocation occur, monopolar implants are easier to reduce (closed) than bipolar. Ceramic heads on monopolar or bipolar arthroplasties offer reduced wear and less erosion of the acetabulum. Total hip arthroplasty provides early mobilization, long-term pain relief, and little additional morbidity at surgery. The increased rate of early dislocation may be related to surgeon skill rather than an inherent failure of the system. If the early dislocators are removed from consideration, the complication rate drops to equal that of monopolar and bipolar implants. Total hip arthroplasty also is cost effective. Total hip arthroplasty may be the only option if pre-existing arthritis, significant osteoporosis, or Paget's disease of the pelvis is present.