Relationship between surgical volume and early outcomes of total hip arthroplasty: do results continue to get better?

This retrospective study explored the relationship between the volume of total hip arthroplasties (THA) and postoperative mortality and early complications from a single institution. One thousand hip arthroplasties in 932 patients were identified during a 1-year period, which included 786 primary and 214 revision hip arthroplasties. The postoperative 6-month combined medical and orthopedic complication rate for primary and revision THA was 7.9% and 16.5%, respectively. The 6-month mortality rate for the overall group was 0.5% (5 deaths), for the primary hips was 0.4% (3 deaths), and for the revision hip was 0.9% (2 deaths). The mortality and complication rates of many surgical procedures, including joint arthroplasties, are inversely related to hospital and surgical volume. The reduction in complication rate, however, approaches a plateau and does not improve regardless of an increase in the surgical and hospital volume.

Complications associated with reimplantation after girdlestone arthroplasty.

Complications associated with reimplantation of a total hip arthroplasty after resection or Girdlestone arthroplasty for treatment of an infected hip are not well-documented. Forty-four hips in 44 patients with a minimum 2-year followup (range, 2-9 years) from the time of reimplantation total hip arthroplasty were evaluated retrospectively. The average Harris hip score changed from 40 preoperatively to 78 at the latest followup. One patient had persistent infection requiring rerevision surgery, and another patient had rerevision surgery for recurrent dislocation. Complications related to the prosthesis consisted of dislocations in five patients (11.4%), recurrent infection in one patient (2.3%), trochanteric nonunion in four patients (9.1%), hematoma in one patient, heterotopic ossification in one patient, and postoperative wound drainage in one patient. Resection arthroplasty of the hip is highly effective in eradicating infection. In the current series, 97.7% of patients were free of infection at the latest followup. However, with an 11.4% dislocation rate and 39% of patients having a persistent limp, alternative approaches need to be evaluated which might reduce these complications.

Ten to fifteen-year follow-up after total hip arthroplasty with a tapered cobalt-chromium femoral component (tri-lock) inserted without cement.

BACKGROUND: Fixation of the femoral component of a total hip arthroplasty without cement has had variable results. While tapered stems appear to have consistently good results, the duration of follow-up in many series has been relatively short. The purpose of this study was to present a longer-term (ten to fifteen-year) follow-up after total hip arthroplasty with insertion of a tapered femoral component without cement. METHODS: Sixty-seven total hip arthroplasties were performed with insertion of a tapered, cobalt-chromium femoral component without cement in fifty-eight patients from 1983 to 1986. Thirteen patients (fifteen hips) died prior to the fifteen-year follow-up examination, and three patients (three hips) were lost to follow-up after ten years, leaving forty-two patients (forty-nine hips) who were followed clinically for a mean of fifteen years. Thirty-seven of the forty-nine hips were followed radiographically for fifteen years, and the remaining twelve were followed for a minimum of ten years. RESULTS: The mean preoperative Charnley score was 3.0 points for pain, 2.7 points for function, and 3.2 points for motion. At the time of the final follow-up, the mean scores were 5.6, 5.6, and 5.2 points, respectively. Although no preoperative Harris hip scores were available, the mean score at the time of the latest follow-up was 92 points (range, 78 to 100 points). There were no revisions because of isolated aseptic loosening of the femoral component (although revision because of aseptic loosening of the acetabular component led to femoral component revision in seven hips). Two femoral components showed radiographic evidence of instability. At fifteen years, the prevalence of thigh pain was 2%. No femoral component that was thought to be stable, with bone ingrowth at two years, lost fixation. CONCLUSIONS: The design features of this cobalt-chromium femoral component (i.e., the collarless, tapered, wedge fit with circumferential porous coating) are thought to be crucial to the achievement of the good-to-excellent results seen in this study.

Hip arthroscopy: a unique inferomedial approach to bullet removal.

Most arthroscopic approaches allow for inspection of the lateral part of the hip joint, but visualization of the medial part is difficult. This article describes the removal of a bullet lodged in the right femoral head of a 33-year-old man. By using an inferomedial arthroscopic approach, we avoided a formal arthrotomy and the disadvantages of other arthroscopic approaches, which include the need for alternate portals, the need for traction, and the risk of both articular cartilage and acetabular labrum damage. The authors believe that this case demonstrates the effective use of the inferomedial arthroscopic approach as an alternative method for removing foreign bodies.

Estudo aberto, randomizado, comparativo, para avaliar a eficácia da enoxaparina comparada à heparina näo fracionada na profilaxia do trombo-embolismo venoso em pacientes submetidos a artroplastia total do quadril pela mesma equipe ortopédica / Open, randomized, comparative study to evaluate the efficacy of enoxaparin as compared to unfractionated heparin in the prophylaxis of venous thromboembolism in patients who underwent total hip replacement

O presente estudo tem como objetivo avaliar a eficácia e segurança da enoxaparina na profilaxia do tromboembolismo venoso em pacientes submetidos a artroplastia total do quadril, comparada com a heparina convencional não fracionada. Setenta pacientes foram submetidos a artroplastia total do quadril de dezembro de 1996 a junho dw 1997. Destes, 34 fizeram uso de heparina não fracionada para prevenir tromboembolismo venoso. Dos 70 pacientes, 11 tiveram trombose profunda no pós-operatório, comprovada por flebografia, sendo que 5 pertenciam ao grupo enoxaparina e 6 ao grupo heparina não fracionada. Um paciente evoluiu para óbito por embolia pulmonar...

Infecçöes ósteo-articulares em crianças / Osteoarticular infections in children

Os autores apresentam os aspectos mais importantes que devem ser considerados na abordagem das infecçöes osteo-articulares na criança. Também enfatizam a necessidade de estabelecer diagnóstico e tratamento precoces, para obtençäo de melhores resultados

Lombalgia / Low back pain

Dor lombar é um sintoma bastante comum que pode ter sua origem em vários tecidos adjacentes a coluna vertebral. O presente trabalho revisa alguns aspectos genéricos da história, exame físico, radiologia e tratamento desse problema. Caracteriza tambéem o síndrome lombar agudo e crônico e os diferentes diagnósticos que devem ser considerados.

Dor nos membros inferiores / Pain in the lower limbs

Os autores revisam as principais causas de dor nos membros inferiores enfocando os aspectos clínicos que contribuem para o diagnóstico diferencial entre os quadros oriundos dos sistemas músculos-esquelético, nervoso e vascular.