Incisional cellulitis after total hip replacement.

We report 16 cases of erythematous eruption on the skin within the flaps of the surgical incision after primary total hip replacement over an eight-year period. The symptoms began within nine months of operation in 13 hips, and two to three years after in three. Four patients had recurrent episodes. All were treated with antibiotics (15 intravenous, one oral) with complete resolution of the eruption within one to six days. The mean follow-up after the last episode of cellulitis was 27 months (14 to 76). There were no cases of periprosthetic sepsis or other sequelae.

Fixation of the acetabular component. The case for cement.

The long-term success rate of cemented sockets in total hip arthroplasty has been well documented in patients who are 60 years of age and older and who have had a followup of as many as 16 years. The failures with cemented sockets have been observed in young patients, patients with poor bone stock (rheumatoid and dysplastic hips) with metal backed components, and in revision surgery with loss of acetabular bone. Ranawat et al have shown that most mechanical failures of cemented socket fixation within 10 years of primary operation is attributable to failure to achieve a good fixation initially of the cement and bone. Volumetric wear of the polyethylene of a cemented socket against a 22- or 28-mm femoral head is compared with the metal backed cemented and noncemented cups. The increase in volumetric polyethylene particles with metal backed cemented sockets and noncemented sockets will induce histiocytic response. The mechanism of histiocytic invasion should be similar for cemented all polyethylene sockets and noncemented sockets. It manifests itself in the cemented socket as global radiolucency when the socket is loose and as osteolysis when it is well fixed for noncemented and cemented sockets. If the number of particles coming out in a noncemented and hybrid total hip replacement are greater, osteolysis would be expected to increase with longer followup. The technique of cemented polyethylene sockets requires organization of the surgical team and hypotensive epidural anesthesia. Under these conditions the procedure is very reproducible. As far as cost is concerned, the all polyethylene socket is significantly less expensive. It seems that cemented total hip replacement is most suitable and perhaps is the right kind of operation for treating osteoarthritis of the hip for patients who are 60 years of age and older because the procedure is reproducible, the quality of arthroplasty is excellent, and it is durable, lasting as many as 15 years in 90% to 95% of the cases.

Supracondylar femoral fracture above a PFC posterior cruciate-substituting total knee arthroplasty treated with supracondylar nailing. A unique technical problem.

Supracondylar fracture above a total knee arthroplasty with a posterior cruciate-substituting design presents a challenging problem to the orthopaedic surgeon. The standard treatment using a intramedullary rod is made difficult by the design of the PFC cruciate-substituting total knee arthroplasty (Johnson & Johnson Orthopaedics, Raynham, MA), which prevents entry of a standard supracondylar nail to the medullary canal of the femur. A technique for using an interlocking intramedullary rod to treat a supracondylar fracture above a posterior cruciate-substituting total knee arthroplasty is described. A case is presented illustrating this technique.

Prediction of the long-term durability of all-polyethylene cemented sockets.

A retrospective study was done to determine the correlation between the rate of aseptic loosening and the early radiographic appearance of the bone-cement interface of the acetabulum of primary cemented total hip prostheses. Two hundred thirty-six hips implanted with modern cement technique were studied during an average clinical and radiographic followup of 9 years. Early radiographs and the last available radiographs were studied by 3 independent observers, and the quality of the bone-cement interface was evaluated with a standardized scoring system. On the acetabular side, the authors noted 0.8% clinical failure, a 3% rate of radiographic migration, and a 3.4% rate of progressive global radiolucency. Only 2.2% of hips considered well fixed on the postoperative film were loose. Of the hips considered not well fixed, the rate of aseptic loosening was 14.4%. The authors conclude that (1) the state of the bone-cement interface as seen on the early postoperative radiograph can predict the longevity of a cemented socket with a high degree of probability, and that (2) cementation of an all-polyethylene socket using modern cement technique is an excellent method of fixation for patients 60 years of age and older with degenerative joint disease.

Total hip replacement arthroplasty in patients with inflammatory arthritis.

1. Hip involvement in inflammatory arthritis is a relatively common entity. 2. Total hip replacement offers the most reliable surgical treatment option for pain relief and the restoration of hip function when medical management is exhausted. 3. Preoperative evaluation and perioperative medical management should focus on the particular medical problems of patients with systemic rheumatologic conditions. 4. In patients without protrusio deformity, cemented total hip replacement with modern cement technique offers excellent long-term functional results.

Predictors of neurovascular displacement in hands with Dupuytren's contracture.

A prospective study of hands with Dupuytren's contracture was designed to test the association of three variables, the presence of an interdigital soft tissue mass, the presence of flexion contractures at each digital joint, and the duration of contracture, with the formation of spiral nerves. 66 digits in 37 hands affected by Dupuytren's disease were examined intra-operatively. Of the 34 digits (52%) with spiral nerves, 28 had soft tissue masses (42%). The sensitivity of a soft tissue mass alone as a predictor of a spiral nerve was 59% and the specificity 75%. The presence of a flexion contracture at the PIP joint had a sensitivity of 88% and a specificity of 62% for the presence of a spiral nerve. The combination of a soft tissue mass and a PIP joint contracture was a very specific (94%) but not a particularly sensitive (50%) test for spiral nerve formation. The formation of a spiral nerve is progressive, occurring most often in hands with significant PIP joint contractures with or without soft tissue interdigital masses.

Differential hemoglobin synthesis in murine erythroleukemic cells: hemin effects.

The addition of butyric acid to murine erythroleukemic cells (clone T3Cl2) induced the cells to differentiate, producing adult hemoglobin (A, alpha 2,beta 2) and an embryonic hemoglobin (E2, alpha 2Y2). The subsequent addition of hemin to the differentiating cells increased the synthesis of adult hemoglobin four-fold and the synthesis of embryonic hemoglobin two-fold; the relative synthesis of the alpha and beta globins increased more than the y globin. The embryonic hemoglobin was expressed prior to the adult hemoglobin in differentiating cells.